Radiographic, clinical, and prognostic features of complicated and uncomplicated community-acquired lobar pneumonia in children.
OBJECTIVE
The incidence of community-acquired lobar pneumonia in conjunction with either necrosis or empyema in children has rapidly increased in recent years. This study aimed to evaluate the radiographic, clinical, and predicted factors of complicated and uncomplicated lobar pneumonia in children.


METHODS
This retrospective study included 131 patients younger than 18 years of age with community-acquired lobar pneumonia treated between January 2002 and March 2005. Multiple logistic regression analysis was performed to demonstrate the risk factors of complicated lobar pneumonia.


RESULTS
The proportion of children with lobar pneumonia in children increased dramatically from 7% in 2002 to 19% in 2004. Analysis revealed the presence of elevated C-reactive protein level (>12 mg/dL) [odds ratio (OR), 3.51; 95% confidence interval (CI), 1.61-7.66], persistent fever for more than 1 week before admission (OR, 1.14; 95% CI, 1.04-1.26), and multilobar (> or =2 lobes) confluent lung opacity on chest radiographs (OR, 2.83; 95% CI, 1.27-6.33) were independent predictors of the occurrence of complicated lobar pneumonia. A progressive increase in the number of penicillin-non-susceptible Streptococcus pneumoniae isolates was found during the study period. Prolonged fever was a common clinical feature of hospitalized children with lobar pneumonia. Failure of consolidative pneumonia to respond to appropriate antibiotic treatment within 4.4 days was associated with the development of necrosis or empyema.


CONCLUSIONS
Complicated and uncomplicated lobar pneumonia are difficult to distinguish based on clinical symptoms at the time of admission. The presence of the above risk factors can help in the early diagnosis of complicated lobar pneumonia.
Lin
Chao-Jen
CJ
Department of Pediatrics, Changhua Christian Children's Hospital, Changhua, Taiwan.
Chen
Po-Yen
PY
Huang
Fang-Liang
FL
Lee
Tain
T
Chi
Ching-Shiang
CS
Lin
Ching-Yuang
CY
D002097:C-Reactive Protein / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology; D004351:Drug Resistance; D004653:Empyema / Q000209:etiology; D005260:Female; D005334:Fever / Q000473:pathology; D006801:Humans; D007223:Infant; D008297:Male; D009336:Necrosis / Q000473:pathology; D010406:Penicillins / Q000494:pharmacology; D011018:Pneumonia, Pneumococcal / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013296:Streptococcus pneumoniae / Q000187:drug effects / Q000302:isolation & purification; D013624:Taiwan / Q000453:epidemiology
D010406:Penicillins; D002097:C-Reactive Protein