Time to Clinical Stability in Children With Community-Acquired Pneumonia

• Published in: Pediatrics (Evanston) Vol. 153; no. 5
• Main Authors: Field, Madeline R, Ambroggio, Lilliam, Lorenz, Douglas, Shah, Samir S, Ruddy, Richard M, Florin, Todd A
• Format: Journal Article
• Language: English
• Published: United States American Academy of Pediatrics 01-05-2024
• Subjects: Adolescent; Child; Child, Preschool; Children; Childrens health; Clinical outcomes; Cohort Studies; Community-Acquired Infections; Female; Heart rate; Heart Rate - physiology; Hospitalization; Humans; Hypoxemia; Hypoxia; Infant; Male; Pneumonia; Pneumonia - diagnosis; Prospective Studies; Respiration; Respiratory Rate - physiology; Severity of Illness Index; Time Factors
• ISSN: 0031-4005; 1098-4275
• DOI: 10.1542/peds.2023-063480

Time to clinical stability (TCS) is a commonly used outcome in adults with community-acquired pneumonia (CAP), yet few studies have evaluated TCS in children. Our objective was to determine the association between TCS and disease severity in children with suspected CAP, as well as factors associated with reaching early stability.
This is a prospective cohort study of children (aged 3 months to 18 years) hospitalized with suspected CAP. TCS parameters included temperature, heart rate, respiratory rate, and hypoxemia with the use of supplemental oxygen. TCS was defined as time from admission to parameter normalization. The association of TCS with severity and clinical factors associated with earlier TCS were evaluated.
Of 571 children, 187 (32.7%) had at least 1 abnormal parameter at discharge, and none had ≥3 abnormal discharge parameters. A greater proportion of infants (90 [93%]) had all 4 parameters stable at discharge compared with 12- to 18-year-old youths (21 [49%]). The median TCS for each parameter was <24 hours. Younger age, absence of vomiting, diffusely decreased breath sounds, and normal capillary refill were associated with earlier TCS. Children who did not reach stability were not more likely to revisit after discharge.
A TCS outcome consisting of physiologic variables may be useful for objectively assessing disease recovery and clinical readiness for discharge among children hospitalized with CAP. TCS may decrease length of stay if implemented to guide discharge decisions. Clinicians can consider factors associated with earlier TCS for management decisions.