PERN Pneumonia Study

Predicting Severe Pneumonia in the Emergency Department: A Global Study of the Pediatric Emergency Research Networks

Study Summary

Pneumonia is one of the most common serious bacterial infections in children worldwide, an important case of childhood morbidity and mortality globally, and a frequent and costly cause of Emergency Department (ED) visits and hospitalizations. Physicians currently rely on subjective impressions of clinical appearance to make initial site-of-care decisions. Such subjective judgments tend to overestimate disease severity in children with pneumonia; such overestimates are associated with the decision to hospitalize patients at low risk. There is currently no evidence-based, validated tool to assist physicians in making targeted site-of-care and management decisions for children with Community-Acquired Pneumonia (CAP). An evidence-based clinical prediction rule for CAP severity in children would assist physicians to accurately risk stratify children with CAP in the ED and improve clinical decisions. The objective of this study is to develop a clinical prediction rule to accurately identify children with CAP who are risk for low, moderate and severe disease. This study will be a prospective cohort study using a convenience sample of approximately 5000 children diagnosed with CAP at EDs across the globe. Most sites will be part of the Pediatric Emergency Research Networks (PERN). Together, the research networks participating in PERN have access to data from over 3 million pediatric ED presentations annually, and to more than 100 hospitals, in five of the six WHO regions. We will include children 3 months to <14 years of age with a clinical diagnosis of pneumonia. We will exclude children with an ED/hospital visit within 7 days prior to the study visit, those with hospital-acquired pneumonia and those with chronic complex conditions. Clinical, laboratory and imaging data from the ED visit and hospitalization will be collected. A follow-up survey will be completed after the visit to assess clinical outcomes. Ordinal logistic regression models, assuming a partial proportional odds specification, and recursive portioning will be used to develop the risk prediction models.

Objectives

  1. To identify predictors of disease severity in pediatric CAP, including the need for hospitalization, empyema, respiratory failure, sepsis and death, in a large, global cohort of EDs
  2. To develop a clinical prediction rule that would accurately identify children with CAP who are at risk for low, moderate and severe disease
  3. To describe variation in the ED management of children with CAP, including diagnostic testing and treatment decisions, in a large, global cohort of EDs
  4. To compare the effectiveness of three different antibiotic strategies in pediatric CAP: b-lactams versus cephalosporins versus macrolides

Principal Study Investigator: Dr. Todd Florin

Leading Institution: Ann & Robert H. Lurie Children's Hospital of Chicago

PERT Site Investigator: Dr. Stephen Freedman

PERT Site Research Coordinator: Kelly Kim

Study Team: Dr. Nathan Kuppermann, Dr. Mark Neuman, Dr. Amy Plint, Dr. Santi Mintegui, Dr. Franz Babl, Dr. Stuart Dalziel, Dr. Michelle Eckerle