Effect of introducing the score of prediction of risk of unfavourable flow of necrotic pneumonia on clinical outcomes in children with bacterial pneumonia

Abstract

Introduction: Purulent destructive pneumonia, massive necrosis of lung tissue, is a serious, often fatal, complication of lobar infiltrative pneumonia. Improvement in treatment of children with bacterial pneumonia may result in potentially preventable complications. It is necessary to identify patients at risk with easy assessable signs which can predict the development of complications. The goal of this study was to develop and validate available and effective Score for predicting the risk of development of necrotic complications of lobar pneumonia in children. The aim was to collect physiological data which were prior to development of purulent – necrotic complications. Materials and methods: The study was performed in Odessa Regional Children's Clinical Hospital. 150 retrospective cases of lobar pneumonia by the period from 2010 to 2015 were analysed in the study. It was developed the Score of prediction of risk of unfavourable flow of necrotic pneumonia using simple algorithms based on observations that include history of previous hospitalizations, saturation (SatO2), volume of affected lung (X-ray findings), quantity of white blood cells (WBC), pH of pleural liquid and level of γ-globulins. Data sets for which outcome (i.e. development of necrotic complication or hospital discharge) could be identified were included to the analysis. Data was analyzed using the Statistical Package for Social Sciences (Version 10, SPSS Inc., Chicago, IL). For normally distributed data, results are given as means and standard deviations (SD). For non-parametric data, medians and interquartile ranges (IQR) are given. Unpaired t-tests were used to compare mean variables in control and intervention groups and the Mann–Whitney U-test to compare medians in non-parametricvariables. The Chi-squared test and Fisher's exact test were used to compare categorical variables. A pvalue of less than 0.05 was considered significant.Conclusion:We are convinced that the Score of prediction of risk of unfavorable flow of necrotic pneumonia is a suitable scoring tool to identify children with lobar pneumonia at risk of development of complications. However, outcomes in medical emergency admissions are influenced by a multitude of factors. To impact on outcomes the Score of prediction of risk of unfavorable flow of necrotic pneumonia has to be placed into an educational context of improved training in emergency medicine. Systematic feedback of adverse outcomes and near misses might further enhance care and show the true potential of the Score of prediction of risk of unfavorable flow of necrotic pneumonia in the management of children with lobar bacterial pneumonia.