title: Lethality by pneumonia and factors associated to death.
abstract: OBJECTIVE
  To describe the case-fatality rate (CFR) and risk factors of death in children with community-acquired acute pneumonia (CAP) in a pediatric university hospital.
  
  
  METHODS
  A longitudinal study was developed with prospective data collected from 1996 to 2011. Patients aged 1 month to 12 years were included in the study. Those who left the hospital against medical orders and those transferred to ICU or other units were excluded. Demographic and clinical-etiological characteristics and the initial treatment were studied. Variables associated to death were determined by bivariate and multivariate analysis using logistic regression.
  
  
  RESULTS
  A total of 871 patients were selected, of whom 11 were excluded; thus 860 children were included in the study. There were 26 deaths, with a CFR of 3%; in 58.7% of these, penicillin G was the initial treatment. Pneumococcus was the most common pathogen (50.4%). From 1996 to 2000, there were 24 deaths (93%), with a CFR of 5.8% (24/413). From 2001 to 2011, the age group of hospitalized patients was older (p = 0.03), and the number of deaths (p = 0.02) and the percentage of disease severity were lower (p = 0.06). Only disease severity remained associated to death in the multivariate analysis (OR = 3.2; 95%CI: 1.2-8.9; p = 0.02).
  
  
  CONCLUSIONS
  When the 1996-2000 and 2001-2011 periods were compared, a significant reduction in CFR was observed in the latter, as well as a change in the clinical profile of the pediatric inpatients at the institute. These findings may be related to the improvement in the socio-economical status of the population. Penicillin use did not influence CFR.
authors.affiliation: Department of Pediatrics, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil. Electronic address: sidneifer@superig.com.br.
authors.forename: Sidnei
authors.initials: S
authors.lastname: Ferreira
authors.affiliation: Department of Pediatrics, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
authors.forename: Clemax C
authors.initials: CC
authors.lastname: Sant'anna
authors.affiliation: Department of Pediatrics, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
authors.forename: Maria de Fátima B P
authors.initials: Mde F
authors.lastname: March
authors.affiliation: Municipal Health Secretariat, Rio de Janeiro, RJ, Brazil.
authors.forename: Marilene Augusta R C
authors.initials: MA
authors.lastname: Santos
authors.affiliation: Department of Pediatrics, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
authors.forename: Antonio Jose Ledo A
authors.initials: AJ
authors.lastname: Cunha
mesh_terms: D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D015999:Multivariate Analysis; D010400:Penicillin G / Q000627:therapeutic use; D011014:Pneumonia / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality*; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D010400:Penicillin G
keywords: Case-fatality rate; Hospitais pediátricos; Inpatients; Letalidade; Pacientes internados; Pediatric hospitals; Penicilina G; Penicillin G; Pneumococcal pneumonia; Pneumonia pneumocócica