title: Management and outcomes of pneumonia among children with complex chronic conditions.
abstract: BACKGROUND
  Although pneumonia is a common reason for pediatric hospitalization among children with complex chronic conditions (CCC), treatment and outcomes have not been well-described. We characterized the presentation, management and outcomes of pneumonia in children with and without CCC and described how antibiotic management and outcomes vary among subgroups of children with CCC.
  
  
  METHODS
  We conducted a cohort study of children <18 years with pneumonia across a large sample of US hospitals. Children were grouped according to CCC subgroups. Differences in disease management and outcomes were assessed using multivariable regression.
  
  
  RESULTS
  Of the 31,684 children in our cohort, 11.9% had CCC. Children with CCC were more likely to receive intensive investigations and therapies, were less likely to receive aminopenicillins or third generation cephalosporins and were more likely to receive antibiotics against methicillin-resistant Staphylococcus aureus, Pseudomonas aeruginosa and anaerobes. Compared with children without these conditions, children with CCC had significantly increased length of stay [relative risk 1.43, 95% confidence interval (CI) 1.39-1.48] and hospital costs (relative risk 1.38, 95% CI 1.33-1.43), with increased odds of antibiotic escalation (odds ratio 1.51, 95% CI 1.35-1.70), pneumonia complications (odds ratio 1.47, 95% CI 1.24-1.75) and readmission (odds ratio 4.0, 95% CI 3.2-5.0).
  
  
  CONCLUSIONS
  Children with CCC comprise a significant proportion of children hospitalized for pneumonia and are at substantially increased risk of adverse outcomes. They have high rates of treatment with broad spectrum antibiotics, both at the time of hospitalization and subsequently. Research is needed to inform decision-making and guideline development, with goals of reducing adverse outcomes and unnecessary variation in management among children with CCC.
authors.affiliation: From the *Division of Pediatric Hospital Medicine, Department of Pediatrics, Tufts University School of Medicine, Boston; †Center for Quality of Care Research; ‡Division of General Internal Medicine, Baystate Medical Center, Springfield; §Department of Medicine, Tufts University School of Medicine, Boston; and ¶Department of Public Health, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA.
authors.forename: JoAnna K
authors.initials: JK
authors.lastname: Leyenaar
authors.forename: Tara
authors.initials: T
authors.lastname: Lagu
authors.forename: Meng-Shiou
authors.initials: MS
authors.lastname: Shieh
authors.forename: Penelope S
authors.initials: PS
authors.lastname: Pekow
authors.forename: Peter K
authors.initials: PK
authors.lastname: Lindenauer
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease / Q000453:epidemiology*; D015897:Comorbidity; D016208:Databases, Factual; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000706:statistics & numerical data; D011014:Pneumonia / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology*; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents
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