Author:
Antonelli Fabio,De Brasi Daniele,Siani Paolo
Abstract
Abstract
Background
Community-acquired pneumonia (CAP) is a common disease, responsible for significant healthcare expenditures, mostly because of hospitalization. Many practice guidelines on CAP have been developed, including admission criteria, but a few on appropriate hospitalization in children. The aim of this study was to evaluate appropriate hospital admission for CAP in a pediatric population.
Methods
We evaluated appropriate admission to a Pediatric Unit performing a retrospective analysis on CAP admitted pediatric patients from a Southern Italy area. Diagnosis was made based on clinical and radiological signs. Appropriate hospital admission was evaluated following clinical and non-clinical international criteria. Family ability to care children was assessed by evaluating social deprivation status.
Results
In 2 winter seasons 120 pediatric patients aged 1-129 months were admitted because of CAP. Median age was 28.7 months. Raised body temperature was scored in 68.3% of patients, cough was present in 100% of cases, and abdominal pain was rarely evidenced. Inflammatory indices (ESR and CRP) were found elevated in 33.3% of cases. Anti-Mycoplasma pneumoniae antibodies were found positive in 20.4%. Trans-cutaneous (TC) SaO2 was found lower than 92% in 14.6%. Dyspnoea was present in 43.3%. Dehydration requiring i.v. fluid supplementation was scored in 13.3%. Evaluation of familial ability to care their children revealed that 76% of families (derived from socially depressed areas) were "at social risk", thus not able to appropriately care their children. Furthermore, analysis of CAP patients revealed that "at social risk" people accessed E.D. and were hospitalized more frequently than "not at risk" patients (odds ratio = 3.59, 95% CI: 1,15 to 11,12; p = 0.01), and that admitted "at social risk" people presented without clinical signs of severity (namely dyspnoea, and/or SaO2 ≤ 92%, and/or dehydration) more frequently than "not at risk" population (p = 0.005).
Conclusion
Dyspnoea was found to be the main clinical criterion to define an appropriate children admission for CAP. Other more objective evaluation (i.e. oxygen pulse oxymetry) could underestimate the necessity of hospitalization as patients discomfort could be more severe then indicated by TC SaO2. Furthermore, family inability to children care represents the main criterion for hospital admission in our geographic area. It reflects social deprivation status and it should be strongly considered in deciding for children hospital admission.
Publisher
Springer Science and Business Media LLC
Reference12 articles.
1. Brown PD: Adherence to Guidelines for Community-Acquired Pneumonia. Does it Decrease Cost of Care?. Pharmacoeconomics. 2004, 22: 413-420. 10.2165/00019053-200422070-00001.
2. British Thoracic Society of Standards of Care Committee: BTS Guidelines for the Management of Community Acquired Pneumonia in Childhood. Thorax. 2002, 57: i1-i24.
3. Migliorati PL, Boccoli E, Bracci LS, Sestini P, Melani AS: A survey on hospitalized community-acquired pneumonia in Italy. Monaldi Arch Chest Dis. 2006, 65: 82-8.
4. Flanders SA, Halm EA: Guidelines for community-acquired pneumonia: are they reflected in practice?. Treat Respir Med. 2004, 3: 67-77. 10.2165/00151829-200403020-00001.
5. Clark JE, Hammal D, Hampton F, Spencer D, Parker L: Epidemiology of community-acquired pneumonia in children seen in hospital. Epidemiology and Infection. 2007, 135: 262-269. 10.1017/S0950268806006741.
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