In-hospital mortality risk stratification in children aged under 5 years with pneumonia with or without pulse oximetry: A secondary analysis of the Pneumonia REsearch Partnership to Assess WHO REcommendations (PREPARE) dataset.
Hooli S., King C., McCollum ED., Colbourn T., Lufesi N., Mwansambo C., Gregory CJ., Thamthitiwat S., Cutland C., Madhi SA., Nunes MC., Gessner BD., Hazir T., Mathew JL., Addo-Yobo E., Chisaka N., Hassan M., Hibberd PL., Jeena P., Lozano JM., MacLeod WB., Patel A., Thea DM., Nguyen NTV., Zaman SM., Ruvinsky RO., Lucero M., Kartasasmita CB., Turner C., Asghar R., Banajeh S., Iqbal I., Maulen-Radovan I., Mino-Leon G., Saha SK., Santosham M., Singhi S., Awasthi S., Bavdekar A., Chou M., Nymadawa P., Pape J-W., Paranhos-Baccala G., Picot VS., Rakoto-Andrianarivelo M., Rouzier V., Russomando G., Sylla M., Vanhems P., Wang J., Basnet S., Strand TA., Neuman MI., Arroyo LM., Echavarria M., Bhatnagar S., Wadhwa N., Lodha R., Aneja S., Gentile A., Chadha M., Hirve S., O'Grady K-AF., Clara AW., Rees CA., Campbell H., Nair H., Falconer J., Williams LJ., Horne M., Qazi SA., Nisar YB., Pneumonia REsearch Partnership to Assess WHO REcommendations (PREPARE) study group None.
OBJECTIVES: We determined the pulse oximetry benefit in pediatric pneumonia mortality risk stratification and chest-indrawing pneumonia in-hospital mortality risk factors. METHODS: We report the characteristics and in-hospital pneumonia-related mortality of children aged 2-59 months who were included in the Pneumonia Research Partnership to Assess WHO Recommendations dataset. We developed multivariable logistic regression models of chest-indrawing pneumonia to identify mortality risk factors. RESULTS: Among 285,839 children, 164,244 (57.5%) from hospital-based studies were included. Pneumonia case fatality risk (CFR) without pulse oximetry measurement was higher than with measurement (5.8%, 95% confidence interval [CI] 5.6-5.9% vs 2.1%, 95% CI 1.9-2.4%). One in five children with chest-indrawing pneumonia was hypoxemic (19.7%, 95% CI 19.0-20.4%), and the hypoxemic CFR was 10.3% (95% CI 9.1-11.5%). Other mortality risk factors were younger age (either 2-5 months [adjusted odds ratio (aOR) 9.94, 95% CI 6.67-14.84] or 6-11 months [aOR 2.67, 95% CI 1.71-4.16]), moderate malnutrition (aOR 2.41, 95% CI 1.87-3.09), and female sex (aOR 1.82, 95% CI 1.43-2.32). CONCLUSION: Children with a pulse oximetry measurement had a lower CFR. Many children hospitalized with chest-indrawing pneumonia were hypoxemic and one in 10 died. Young age and moderate malnutrition were risk factors for in-hospital chest-indrawing pneumonia-related mortality. Pulse oximetry should be integrated in pneumonia hospital care for children under 5 years.