title: Admission chest radiographs predict illness severity for children hospitalized with pneumonia.
abstract: OBJECTIVE
  To assess whether radiographic findings predict outcomes among children hospitalized with pneumonia.
  
  
  METHODS
  This retrospective study included children <18 years of age from 4 children's hospitals admitted in 2010 with clinical and radiographic evidence of pneumonia. Admission radiographs were categorized as single lobar, unilateral or bilateral multilobar, or interstitial. Pleural effusions were classified as absent, small, or moderate/large. Propensity scoring was used to adjust for potential confounders, including need for supplemental oxygen, intensive care, and mechanical ventilation, as well as hospital length of stay and duration of supplemental oxygen.
  
  
  RESULTS
  There were 406 children (median age, 3 years). Infiltrate patterns included: single lobar, 61%; multilobar unilateral, 13%; multilobar bilateral, 16%; and interstitial, 10%. Pleural effusion was present in 21%. Overall, 63% required supplemental oxygen (median duration, 31.5 hours), 8% required intensive care, and 3% required mechanical ventilation. Median length of stay was 51.5 hours. Compared with single lobar infiltrate, all other infiltrate patterns were associated with need for intensive care; only bilateral multilobar infiltrate was associated with need for mechanical ventilation (adjusted odds ratio [aOR]: 3.0, 95% confidence interval [CI]: 1.2-7.9). Presence of effusion was associated with increased length of stay and duration of supplemental oxygen; only moderate/large effusion was associated with need for intensive care (aOR: 3.2, 95% CI: 1.1-8.9) and mechanical ventilation (aOR: 14.8, 95% CI: 9.8-22.4).
  
  
  CONCLUSIONS
  Admission radiographic findings are associated with important hospital outcomes and care processes and may help predict disease severity.
authors.affiliation: Monroe Carell Jr. Children's Hospital at Vanderbilt and the Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee.
authors.forename: Lauren
authors.initials: L
authors.lastname: McClain
authors.forename: Matthew
authors.initials: M
authors.lastname: Hall
authors.forename: Samir S
authors.initials: SS
authors.lastname: Shah
authors.forename: Joel S
authors.initials: JS
authors.lastname: Tieder
authors.forename: Angela L
authors.initials: AL
authors.lastname: Myers
authors.forename: Katherine
authors.initials: K
authors.lastname: Auger
authors.forename: Angela M
authors.initials: AM
authors.lastname: Statile
authors.forename: Karen
authors.initials: K
authors.lastname: Jerardi
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Queen
authors.forename: Evan
authors.initials: E
authors.lastname: Fieldston
authors.forename: Derek J
authors.initials: DJ
authors.lastname: Williams
mesh_terms: D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000458:organization & administration; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D010343:Patient Admission; D011014:Pneumonia / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D011859:Radiography; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012720:Severity of Illness Index