Abstract
BackgroundCommunity acquired pneumonia is the primary cause of pediatric hospitalizations and deaths in children under 5 years of age. But the epidemiology of death in pediatric severe community acquired pneumonia was not well characterized.MethodsThis retrospective observational study was performed at the academic Emergency department and intensive care unit and we investigated the timing, cause, mode and attribution of death in children with severe community acquired pneumonia.ResultsOf 962 subjects with severe community acquired pneumonia, there were 57 non-survivors (5.9% mortality). Median time to death was 7 [IQR 3,16] days from severe community acquired pneumonia recognition. Patients dying ≤7 days were younger, had greater illness severity and higher rate of congenital heart disease, who were more likely to die of a cardiovascular cause. Multiple organ dysfunction syndrome predominated in deaths > 7 days. Unsuccessful cardiopulmonary resuscitation was the most common mode of death at all timepoints. Our findings suggested that in pediatric severe community acquired pneumonia, early deaths were due primarily to cardiovascular dysfunction, while later deaths were more commonly due to multiple organ dysfunction syndrome.ConclusionsDeaths from non-pulmonary factors accounted for a substantial portion of non-survivors. Respiratory dysfunction accounted for only a minority of deaths. Our study highlighted limitations associated with rescuing patients with severe pneumonia from death if extrapulmonary organ dysfunctions could not be simultaneously managed.
Highlights
Community acquired pneumonia (CAP) is the top cause of pediatric hospitalizations [1, 2]
Study location and inclusion criteria We conducted a retrospective analysis of all patients treated for severe CAP in the emergency department (ED) and/or PICU at Children’s Hospital affiliated to Chongqing Medical University (CHCMU) who died between January 1, 2016 and December 31, 2018
Patients were included if they aged between 29 days to 5 years, met criteria for severe pneumonia as defined by the British Thoracic Society (BTS) and the Infectious Diseases Society of America (IDSA) [4, 5], were treated in either the ED or PICU, invasively ventilated, and died prior to hospital discharge
Summary
Community acquired pneumonia (CAP) is the top cause of pediatric hospitalizations [1, 2]. Severe pneumonia is responsible for > 75% of these one million of the six million deaths caused by respiratory infections annually in children under 5 years of age [3]. Understanding the epidemiology of death in severe CAP is necessary to set appropriate clinical and research priorities, as children who die early may have distinct risk factors, pathophysiology, and response to therapy than those who die further out from pneumonia recognition. Community acquired pneumonia is the primary cause of pediatric hospitalizations and deaths in children under 5 years of age. The epidemiology of death in pediatric severe community acquired pneumonia was not well characterized
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