Factors predicting mortality in hospitalised HIV-negative children with lower-chest-wall indrawing pneumonia and implications for management.
Gallagher KE., Awori JO., Knoll MD., Rhodes J., Higdon MM., Hammitt LL., Prosperi C., Baggett HC., Brooks WA., Fancourt N., Feikin DR., Howie SRC., Kotloff KL., Tapia MD., Levine OS., Madhi SA., Murdoch DR., O'Brien KL., Thea DM., Baillie VL., Ebruke BE., Kamau A., Moore DP., Mwananyanda L., Olutunde EO., Seidenberg P., Sow SO., Thamthitiwat S., Scott JAG., PERCH Study Group None.
INTRODUCTION: In 2012, the World Health Organization revised treatment guidelines for childhood pneumonia with lower chest wall indrawing (LCWI) but no 'danger signs', to recommend home-based treatment. We analysed data from children hospitalized with LCWI pneumonia in the Pneumonia Etiology Research for Child Health (PERCH) study to identify sub-groups with high odds of mortality, who might continue to benefit from hospital management but may not be admitted by staff implementing the 2012 guidelines. We compare the proportion of deaths identified using the criteria in the 2012 guidelines, and the proportion of deaths identified using an alternative set of criteria from our model. METHODS: PERCH enrolled a cohort of 2189 HIV-negative children aged 2-59 months who were admitted to hospital with LCWI pneumonia (without obvious cyanosis, inability to feed, vomiting, convulsions, lethargy or head nodding) between 2011-2014 in Kenya, Zambia, South Africa, Mali, The Gambia, Bangladesh, and Thailand. We analysed risk factors for mortality among these cases using predictive logistic regression. Malnutrition was defined as mid-upper-arm circumference <125mm or weight-for-age z-score