Time to clinical stability among children hospitalized with pneumonia

Abstract

We evaluated the performance of Time to Clinical Stability (TCS), a longitudinal outcome measure using four physiologic parameters (temperature, heart rate, respiratory rate, and use of supplemental oxygen), among children enrolled in a prospective study of pneumonia hospitalizations. We calculated the time from admission to normalization for each of the four parameters individually and various combinations of these parameters (>2 parameters). We assessed for agreement between the combined TCS measures and both hospital length of stay and an ordinal severity scale (non-severe, severe, and very severe). Overall, 323 (96.7%) of 334 included children had ≥1 parameter abnormal on admission; 70 (21%) children had ≥1 parameter abnormal at discharge. For the four combined measures, median TCS decreased with increasing age. Increasing TCS was associated with both longer length of stay and increasing disease severity. The simplest combined measure incorporating only respiratory rate and need for supplemental oxygen performed similarly to more complex measures including additional parameters. Our study demonstrates that longitudinal TCS measures may be useful in children with pneumonia, both in clinical settings to assess recovery and readiness for discharge, and as an outcome measure in research and quality assessments. Additional study is needed to further validate our findings.

Time to recovery and predictors of severe community-acquired pneumonia among pediatric patients in Debre Markos referral hospital, North West Ethiopia: A retrospective follow-up study

“…This study indicated that younger children recover sooner than older ones. This finding is in line with the study conducted on time to clinical stability among hospitalized children that reported higher hospital stay among children above five years than below [9]. The current finding is also supported by a study conducted in Italy on the prediction of delayed recovery from pediatric community-acquired pneumonia [19].…”

“…The finding of this study is almost similar to the study conducted in the rural health center of the Gambia which reported that the meantime of recovery was 4.5 days [16]. The finding of this study is higher than the study done at Vanderbilt (2.3days)and Nepal (2days) [9,17]. This variation might be due to case-mix, severity, and co-morbidity differences.…”

“…Another study noted that as a median time of clinical stability increases, the severity of pneumonia also increases significantly [9]. A prospective observational study on the Severity of Pneumonia in under-five children also showed that the length of hospitalization days varied for children with hypoxemia and without hypoxemia [10].…”

Radiologic Diagnosis and Hospitalization among Children with Severe Community Acquired Pneumonia: A Prospective Cohort Study

“…In this study, the only clinical finding that discriminated significantly between children with radiographically confirmed pneumonia and those with normal CXR was degree of fever. Higher body temperature has been associated with delay in achieving clinical stability, although pattern of fever was not associated with radiologic findings [26].…”

Discharge Before Return to Respiratory Baseline in Children with Neurologic Impairment

“…With the growing emphasis on decreasing hospital costs, concern exists that patients are being discharged from hospitals "quicker and sicker," 18,19 with shortening lengths of stay and higher patient instability at discharge. Clinical instability at discharge has been associated with adverse postdischarge outcomes in adults with pneumonia [20][21][22][23] ; however, studies evaluating discharge readiness have not examined the population of children with NI. Our findings of no difference in reutilization for children with NI discharged before return to respiratory baseline, which would be expected to approximate one or more clinical instabilities, contrast these concerns.…”