title: Clinical predictors of hospital admission in acute lower respiratory tract infection in 2 months to 2-year-old children.
abstract: OBJECTIVE
  Acute lower respiratory tract infections (ALRI) are a common cause of paediatric emergency visits in young children. We studied risk factors for hospitalization and developed a clinical score for predicting hospitalization among 2 months to 2-year-old children with ALRI.
  
  
  METHODS
  We conducted this prospective cohort study in the paediatric emergency department of a tertiary-care teaching hospital in India. Consecutive children, aged 2 months to 2 years with ALRI were enrolled from 15 December 2011 to 14 December 2012. A total of 26 a priori identified, putative risk factors were studied among enrolled children. We determined independent predictors of hospital admission (primary outcome) through multi-variable logistic regression analysis and assimilated them into a clinical risk score using regression coefficients.
  
  
  RESULTS
  A total of 240 children (130 admissions) with ALRI were enrolled. Eleven clinical risk factors, which displayed association with hospital admission on univariate analysis (P < 0.1), were entered into multi-variable logistic regression analysis. Five factors retained independent association and were incorporated in a predictive score for hospitalization: tachypnoea (score of 5), chest retractions (score of 3), temperature > 37.8°C (score of 3), SpO2 < 92% at room air (score of 4), GCS < 15 (score of 6). Area under the receiver operator characteristic curve was 0.80 (95% CI: 0.75-0.85, P < 0.001).
  
  
  CONCLUSIONS
  Five clinical risk factors-tachypnoea, chest retractions, fever > 37.8°C, SpO2 < 92% and GCS < 15-independently predicted hospital admission in infants with ALRI. A novel clinical score predicting hospital admission is presented.
authors.affiliation: Department of Pediatrics, Government Medical College and Hospital, Chandigarh, India.
authors.forename: Vidushi
authors.initials: V
authors.lastname: Mahajan
authors.affiliation: Department of Pediatrics, Government Medical College and Hospital, Chandigarh, India.
authors.forename: Mudita
authors.initials: M
authors.lastname: Tiwari
authors.affiliation: Department of Pediatrics, Government Medical College and Hospital, Chandigarh, India.
authors.forename: Adhi
authors.initials: A
authors.lastname: Arya
authors.affiliation: Department of Pediatrics, Government Medical College and Hospital, Chandigarh, India.
authors.forename: Abhimanyu
authors.initials: A
authors.lastname: Tiwari
authors.affiliation: Department of Pediatrics, Government Medical College and Hospital, Chandigarh, India.
authors.forename: Deepak
authors.initials: D
authors.lastname: Chawla
authors.affiliation: Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Shiv Sajan
authors.initials: SS
authors.lastname: Saini
mesh_terms: D000208:Acute Disease; D002675:Child, Preschool; D005260:Female; D005334:Fever / Q000209:etiology; D015600:Glasgow Coma Scale; D006760:Hospitalization; D006801:Humans; D007194:India; D007223:Infant; D008297:Male; D010100:Oxygen / Q000097:blood; D011446:Prospective Studies; D012372:ROC Curve; D012141:Respiratory Tract Infections / Q000097:blood / Q000150:complications*; D012307:Risk Factors; D059246:Tachypnea / Q000209:etiology
chemical_list: D010100:Oxygen
keywords: bronchiolitis; clinical score; emergency medicine; hospitalization; pneumonia