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BTS severity criteria for paediatric community-acquired pneumonia predict NFH, disposition

15 Sep 2019

The severity criteria of the British Thoracic Society (BTS) guideline for paediatric community-acquired pneumonia (CAP) boast of a fair to excellent capacity in predicting the need for hospitalization (NFH) and disposition, a study has shown.

A total of 518 children met the eligibility criteria, of whom 293 (56.6 percent) were discharged from the emergency department (ED) and 372 met at least one BTS criterion. Although specific, the BTS criteria was sensitive for neither NFH nor disposition.

Sensitivity criteria for NFH in children aged <1 year included not feeding and temperature, while tachycardia, cyanosis and not feeding were the criteria for disposition. For those aged ≥1 year, tachycardia showed a sensitivity of >0.60 for both outcomes.

The areas under the receiver operator characteristic curves for predicting any BTS criteria were 0.57 and 0.84 for NFH and disposition, respectively.

“Although specific, the low sensitivity and poor discriminatory ability for NFH of these criteria suggest a need for improved prognostic tools for children with CAP,” the authors said.

This retrospective cohort study included children aged 3 months to 18 years who were diagnosed with CAP in an urban, paediatric ED in the US from September 2014 to August 2015. Those with chronic medical conditions, recent ED visits and ED transfers were excluded.

Interventions or diagnoses that require hospitalization (ie, NFH) and disposition (eg, admit vs discharge) were the main outcomes. Test characteristics, stratified by age, were calculated for each outcome.

“The BTS guideline for paediatric CAP outlines severity criteria to guide clinical decision-making,” the authors noted.

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