Journal of hospital medicine · 2025
Derivation and validation of the Pediatric Community-Acquired Pneumonia Severity (PedCAPS) score: A prospective cohort study.
СтатьяМногоцентровое исследованиеВалидационное исследованиеНазвание и аннотация: Перевод в очереди
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Florin Todd A, Reeder Ron, Ambroggio Lilliam, Ruddy Richard M, Shah Samir S, Cator Allison, Lipshaw Matthew J, Capraro Geoffrey A, Sartori Laura F, Cheng Amy Y, Tzimenatos Leah, Walsh Patrick S, Morris Claudia R, Rees Chris A, McLaren Son H, Lubell Tamar R, Larsen Chari D, Moher Justin, Klein Eileen J, Hooli Shubhada, Kuppermann Nathan, Pediatric Emergency Care Applied Research Network (PECARN) PedCAPS Investigators
Аннотация
INTRODUCTION: Community-acquired pneumonia (CAP) is a frequent and costly cause of pediatric emergency department (ED) visits and hospitalizations. Previous prognostic tools for CAP are limited by small samples, single-center or retrospective designs, lack of generalizability to ED settings, lack of biomarkers, or limited objective data. To overcome these limitations, we will derive and externally validate a prediction rule for pediatric CAP severity in a large, multicenter prospective cohort.
METHODS: This is a prospective cohort study of children 3 months to 18 years old with CAP who present to EDs within the Pediatric Emergency Care Applied Research Network. Enrollment began 8/2023 and will end 7/2027. We exclude children with recent hospitalizations and chronic conditions (e.g., immunosuppression). A follow-up survey and record review is completed 8-15 days after the visit. Blood and nasal specimens are obtained to evaluate the role of C-reactive protein, procalcitonin, proadrenomedullin, and viral detection in severity prediction. The primary outcome is severity (three-tiered outcome of mild, moderate, or severe CAP) within 7 days of ED presentation. Model derivation will occur in ~4000 children from 7 EDs over 2 years. External validation will occur in a distinct cohort of at least 2000 children from 7 different EDs. Penalized regression, recursive partitioning, and machine learning will be used in model development.
DISCUSSION: At study completion, we will have a validated CAP severity prediction rule well-positioned for implementation and further evaluation. We will also understand the role of specific biomarkers in predicting outcomes in children with CAP.
METHODS: This is a prospective cohort study of children 3 months to 18 years old with CAP who present to EDs within the Pediatric Emergency Care Applied Research Network. Enrollment began 8/2023 and will end 7/2027. We exclude children with recent hospitalizations and chronic conditions (e.g., immunosuppression). A follow-up survey and record review is completed 8-15 days after the visit. Blood and nasal specimens are obtained to evaluate the role of C-reactive protein, procalcitonin, proadrenomedullin, and viral detection in severity prediction. The primary outcome is severity (three-tiered outcome of mild, moderate, or severe CAP) within 7 days of ED presentation. Model derivation will occur in ~4000 children from 7 EDs over 2 years. External validation will occur in a distinct cohort of at least 2000 children from 7 different EDs. Penalized regression, recursive partitioning, and machine learning will be used in model development.
DISCUSSION: At study completion, we will have a validated CAP severity prediction rule well-positioned for implementation and further evaluation. We will also understand the role of specific biomarkers in predicting outcomes in children with CAP.