Whereas complicated pneumonia is associated with high rates of mortality and severe morbidity in adults, previously healthy children can usually expect complete recovery without long-term sequelae. However, pediatric community-acquired complicated pneumonia (PCACP) may have a protracted clinical course, requiring prolonged complicated hospitalizations. Early identification of children at risk for prolonged complicated courses may allow early direction of aggressive therapy and avoidance of over-aggressive therapy for those who are more likely to have a benign, short illness.
For a study published in CHEST, Oded Breuer, MD, and colleagues sought to develop and validate a clinical tool for the prediction of prolonged complicated hospitalizations in children with PCACP. “We found that in children, pleural fluid lactate dehydrogenase (LDH) and glucose were useful parameters for the early prediction of the severity of disease course in CACP,” says Dr. Breuer. “We developed a model based on the level of both pleural fluid LDH and glucose which accurately identifies patients with prolonged hospitalization and from that model derived a simple useful clinical tool—the combination of pleural LDH greater than1000U/L and pleural glucose less than 1mmol/L, or pleural LDH greater than 2000U/L and pleural glucose less than 2mmol/L, or pleural LDH greater than 3000U/L and pleural glucose less than 3mmol/L predicts prolonged hospitalizations in children with complicated pneumonia.”
Dr. Breuer notes that early identification of pediatric patients with complicated pneumonia at risk of a prolonged clinical course offers physicians the opportunity to discuss the expected clinical disease course with patients’ parents. “Early identification also may help physicians and parents make informed decisions on treatment options regarding conservative or invasive treatment and may allow better patient selection for clinical trials for assessing the optimal therapeutic approach for pediatric complicated pneumonia,” he adds.
Predictors of Prolonged Hospitalizations in Pediatric Complicated Pneumonia