Time to clinical stability among children hospitalized with pneumonia.
We evaluated the performance of time to clinical stability (TCS), a longitudinal outcome measure using 4 physiologic parameters (temperature, heart rate, respiratory rate, and use of supplemental oxygen), among children enrolled in a prospective study of pneumonia hospitalizations. We calculated the time from admission to normalization for each of the 4 parameters individually along with various combinations of these parameters (≥2 parameters). We assessed for agreement between the combined TCS measures and both hospital length of stay and an ordinal severity scale (nonsevere, severe, and very severe). Overall, 323 (96.7%) of 334 included children had ≥1 parameter abnormal on admission; 70 (21%) children had ≥1 parameter abnormal at discharge. For the 4 combined measures, median TCS decreased with increasing age. Increasing TCS was associated with both longer length of stay and increasing disease severity. The simplest combined measure incorporating only respiratory rate and need for supplemental oxygen performed similarly to more complex measures including additional parameters. Our study demonstrates that longitudinal TCS measures may be useful in children with pneumonia, both in clinical settings to assess recovery and readiness for discharge, and as an outcome measure in research and quality assessments. Additional study is needed to further validate our findings.
The Monroe Carell Jr. Children's Hospital at Vanderbilt, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee.
Rachel B
RB
Wolf
The Monroe Carell Jr. Children's Hospital at Vanderbilt, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee.
Kathryn
K
Edwards
Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee.
Carlos G
CG
Grijalva
Department of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee.
Wesley H
WH
Self
Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee.
Yuwei
Y
Zhu
Department of Pathology, Vanderbilt University School of Medicine, Nashville, Tennessee.
James
J
Chappell
Centers for Disease Control and Prevention, Atlanta, Georgia.
Anna M
AM
Bramley
Centers for Disease Control and Prevention, Atlanta, Georgia.
Seema
S
Jain
The Monroe Carell Jr. Children's Hospital at Vanderbilt, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee.
Derek J
DJ
Williams
D000293:Adolescent; D017677:Age Distribution; D001831:Body Temperature; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000503:physiopathology; D006339:Heart Rate; D006801:Humans; D007223:Infant; D007902:Length of Stay; D017063:Outcome Assessment, Health Care; D010100:Oxygen / Q000627:therapeutic use; D011014:Pneumonia / Q000503:physiopathology* / Q000628:therapy; D011446:Prospective Studies; D056152:Respiratory Rate; D012720:Severity of Illness Index; D013714:Tennessee
D010100:Oxygen