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American Academy of Pediatrics
Research Articles

Variation in Management and Outcomes of Children With Complicated Pneumonia

Caroline J. Gross, John J. Porter, Susan C. Lipsett, Michael C. Monuteaux, Alexander W. Hirsch and Mark I. Neuman
Hospital Pediatrics February 2021, hpeds.2020-001800; DOI: https://doi.org/10.1542/hpeds.2020-001800
Caroline J. Gross
aDepartment of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts;
bDepartment of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts; and
cDepartment of Pediatrics, Boston Medical Center, Boston, Massachusetts
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John J. Porter
aDepartment of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts;
dDivision of Emergency Medicine and
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Susan C. Lipsett
aDepartment of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts;
bDepartment of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts; and
dDivision of Emergency Medicine and
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Michael C. Monuteaux
aDepartment of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts;
bDepartment of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts; and
dDivision of Emergency Medicine and
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Alexander W. Hirsch
aDepartment of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts;
bDepartment of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts; and
dDivision of Emergency Medicine and
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Mark I. Neuman
aDepartment of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts;
bDepartment of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts; and
dDivision of Emergency Medicine and
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Abstract

OBJECTIVES: To assess the characteristics of children hospitalized with complicated pneumonia at US children’s hospitals and compare these characteristics with those of children hospitalized with community-acquired pneumonia (CAP).

METHODS: We identified children hospitalized with complicated pneumonia (parapneumonic effusion, empyema, necrotizing pneumonia, or lung abscess) or CAP across 34 hospitals between 2011 and 2019. We evaluated differences in patient characteristics, antibiotic selection, and outcomes between children with complicated pneumonia and CAP. We, also, assessed seasonal variability in the frequency of these 2 conditions and evaluated the prevalence of complicated pneumonia over the 9-year study period.

RESULTS: Compared with children hospitalized with CAP (n = 75 702), children hospitalized with complicated pneumonia (n = 6402) were older (a median age of 6.1 vs 3.4 years; P < .001), with 59.4% and 35.2% of patients ≥5 years of age, respectively. Patients with complicated pneumonia had higher rates of antibiotic therapy targeted against methicillin-resistant Staphylococcus aureus (46.3% vs 12.2%; P < .001) and Pseudomonas (8.6% vs 6.7%; P < .001), whereas differences in rates of coverage against mycoplasma were not clinically significant. Children with complicated pneumonia had a longer median hospital length of stay and higher rates of ICU admissions, mechanical ventilation, 30-day readmissions, and costs. Seasonal variation existed in both complicated pneumonia and CAP, with 42.7% and 46.0% of hospitalizations occurring during influenza season. The proportion of pneumonia hospitalizations due to complicated pneumonia increased over the study period (odds ratio 1.04, 95% confidence interval: 1.02–1.06).

CONCLUSIONS: Complicated pneumonia more frequently occurs in older children and accounts for higher rates of resource use, compared to CAP.

  • Copyright © 2021 by the American Academy of Pediatrics
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Hospital Pediatrics: 11 (2)
Hospital Pediatrics
Vol. 11, Issue 2
1 Feb 2021
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Variation in Management and Outcomes of Children With Complicated Pneumonia
Caroline J. Gross, John J. Porter, Susan C. Lipsett, Michael C. Monuteaux, Alexander W. Hirsch, Mark I. Neuman
Hospital Pediatrics Feb 2021, hpeds.2020-001800; DOI: 10.1542/hpeds.2020-001800

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Variation in Management and Outcomes of Children With Complicated Pneumonia
Caroline J. Gross, John J. Porter, Susan C. Lipsett, Michael C. Monuteaux, Alexander W. Hirsch, Mark I. Neuman
Hospital Pediatrics Feb 2021, hpeds.2020-001800; DOI: 10.1542/hpeds.2020-001800
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