Predicting severe pneumonia in the emergency department: a global study of the Pediatric Emergency Research Networks (PERN)—study protocol. Issue 12 (2nd December 2020)

• Record Type: Journal Article
• Authors: Florin, Todd Adam; Tancredi, Daniel Joseph; Ambroggio, Lilliam; Babl, Franz E; Dalziel, Stuart R; Eckerle, Michelle; Mintegi, Santiago; Neuman, Mark; Plint, Amy C; Kuppermann, Nathan
• Other Names: author non-byline.; Ahmad Fahd A author non-byline.; Álvarez-Álvarez Andrea author non-byline.; Arrighini Alberto author non-byline.; Avva Usha author non-byline.; Olivia Elena Aquino author non-byline.; Azubuine Uchechi author non-byline.; Babl Franz E author non-byline.; Gonzalez de Suso Luisa Baron author non-byline.; Bergmann Kelly R author non-byline.; A Bradin Stuart author non-byline.; Breslin Kristen author non-byline.; Borland Meredith L author non-byline.; María Calderón Checa Rosa author non-byline.; Campo Fernández Maria Natali author non-byline.; Campos-Calleja Carmen author non-byline.; Caperell Kerry author non-byline.; Chamberlain James author non-byline.; Chaudhari Pradip P author non-byline.; Cherry Jonathan author non-byline.; Chong Shu-Ling author non-byline.; Chua Wee-Jhong author non-byline.; Murray Ida Concha author non-byline.; Craig Simon author non-byline.; Deepali Thosar author non-byline.; Eckerle Michelle author non-byline.; Espina Pinky-Rose author non-byline.; Fairbrother Susan author non-byline.; Farish Alexandria author non-byline.; Fein Daniel M author non-byline.; Álvarez Ramón Fernández author non-byline.; Florin Todd A author non-byline.; Freedman Stephen author non-byline.; Forward Karen author non-byline.; Gafencu Mihai author non-byline.; Tristán Jara Gaitero author non-byline.; Galetto-Lacour Annick author non-byline.; Gangoiti Iker author non-byline.; Gardiner Michael A author non-byline.; George Shane author non-byline.; Greber-Platzer Susanne author non-byline.; Gómez-Barrena Virginia author non-byline.; Birn Tamara Hirsch author non-byline.; Isacoff Adam author non-byline.; Jani Shefali author non-byline.; Kam April J author non-byline.; Kannikeswaran Nirupama author non-byline.; Kochar Amit author non-byline.; Kuppermann Nathan author non-byline.; Kwok Maria Y author non-byline.; M Lunoe Maren author non-byline.; McKee Ryan author non-byline.; McLaren Son H author non-byline.; McLean Lianne author non-byline.; Meckler Garth D author non-byline.; Midulla Fabio author non-byline.; Mills Erin author non-byline.; Moldovan Diana Aniela author non-byline.; Mora-Capín Andrea author non-byline.; Morales Viera author non-byline.; Morris Claudia R author non-byline.; Morrison Andrea K author non-byline.; Navanandan Nidhya author non-byline.; Neuman Mark I author non-byline.; Oglesby Rebecca author non-byline.; Orfanos Ioannis author non-byline.; Pavlicich Sonia Viviana author non-byline.; Fuenzalida Astrid Pezoa author non-byline.; Plint Amy C author non-byline.; Poonai Naveen author non-byline.; Fosch Mercè Puigdomènech author non-byline.; Rao Arjun author non-byline.; Carlos Romero Miguel Angelats author non-byline.; Sabhaney Vikram author non-byline.; Sahyoun Cyril author non-byline.; Samson Frederic author non-byline.; Shah Nipam P author non-byline.; Calvo Pilar Storch-de-Gracia author non-byline.; Tucker Jennifer author non-byline.; Turner Tristan author non-byline.; Waseem Muhammad author non-byline.; Watkins Nicholas author non-byline.; Wright Bruce author non-byline.; Zorc Joseph author non-byline.;
• Is Part Of: BMJ open. Volume 10:Issue 12(2020)
• Publication Date: 2020-12-02
• Subjects: paediatric A&E and ambulatory care -- paediatric infectious disease & immunisation -- paediatrics; Medicine -- Research -- Periodicals; 610.72
• DOI: 10.1136/bmjopen-2020-041093
• Languages: English
• ISSNs: 2044-6055

Abstract

Abstract : Introduction: Pneumonia is a frequent and costly cause of emergency department (ED) visits and hospitalisations in children. There are no evidence-based, validated tools to assist physicians in management and disposition decisions for children presenting to the ED with community-acquired pneumonia (CAP). The objective of this study is to develop a clinical prediction model to accurately stratify children with CAP who are at risk for low, moderate and severe disease across a global network of EDs. Methods and analysis: This study is a prospective cohort study enrolling up to 4700 children with CAP at EDs at ~80 member sites of the Pediatric Emergency Research Networks (PERN; https://pern-global.com/ ). We will include children aged 3 months to <14 years with a clinical diagnosis of CAP. We will exclude children with hospital admissions within 7 days prior to the study visit, hospital-acquired pneumonias or chronic complex conditions. Clinical, laboratory and imaging data from the ED visit and hospitalisations within 7 days will be collected. A follow-up telephone or text survey will be completed 7–14 days after the visit. The primary outcome is a three-tier composite of disease severity. Ordinal logistic regression, assuming a partial proportional odds specification, and recursive partitioning will be used to develop the risk stratification models. Ethics and dissemination: This study will result in a clinical prediction model to accurately identify risk of severe disease on presentation to the ED. Ethics approval was obtained for all sites included in the study. Cincinnati Children's Hospital Institutional Review Board (IRB) serves as the central IRB for most US sites. Informed consent will be obtained from all participants. Results will be disseminated through international conferences and peer-reviewed publications. This study overcomes limitations of prior pneumonia severity scores by allowing for broad generalisability of findings, which can be actively implemented after model development and validation.