SAN DIEGO — A team of clinicians from Vanderbilt University School of Medicine, the University of Utah School of Medicine, the Centers for Disease Control and others, developed a clinical prediction rule (CPR) that accurately estimates risk for severe outcomes among children hospitalized with pneumonia.
In an abstract presented at IDWeek 2015, Derek J. Williams, MD, MPH, of Children’s Hospital at Vanderbilt University School of Medicine, said that validation of this CPR, which is ongoing, could be used to assess disease severity and inform clinical decision making.
“Most hospitals over-estimate the risk for severe outcomes,” Dr Williams said.
The researchers analyzed data of children enrolled in the Etiology of Pneumonia in the Community Study, a prospective study of community-acquired pneumonia hospitalizations in three U.S. children’s hospitals, to derive the CPR.
They then evaluated three separate CPR models. One included 26 variables, including demographic/epidemiologic variables (eg, age), clinical variables (eg, vital signs), and diagnostic studies (eg, radiologic findings).. The second included 10 of these 26 predictors judged to be most important by a consensus of clinicians.
The third contained nine variables readily available on electronic health records.
Of the 2319 children included in the study, 18% were rated as severe, 14% were rated as moderate, and 79% were rated as mild.
The CPR predictive accuracy was high for all models (c-index 0.78-0.81). The data could be improved, Williams said, with inclusion of children treated in an outpatient setting.
“The CPR could be used to standardize risk assessment and improve care and may also reduce hospitalizations,” he said.
1. Williams, Derek J., Zhu, Yuwei, Self, Wesley H., et al. Predicting Severe Outcomes in Children Hospitalized with Community acquired Pneumonia Abstract #76. Presented at Infectious Disease Week, Oct.. 7–11, 2015,