Viral respiratory infections are a leading cause of illness and hospitalization in young children worldwide. Case fatality rates in pediatric patients with adenoviral lower respiratory tract infection requiring intensive care unit (ICU) admission have been reported between 7 and 22%. We investigated the demographics and clinical characteristics in pediatric mortalities associated with adenoviral respiratory infection at 12 academic children's hospitals in the United States. There were 107 mortality cases included in our study, 73% of which had a chronic medical condition. The most common chronic medical condition was immunocompromised state in 37 cases (35%). The incidences of pediatric acute respiratory distress syndrome (78%) and multiple organ dysfunction syndrome (94%) were profound. Immunocompetent cases were more likely to receive mechanical ventilation within the first hour of ICU admission (60 vs. 14%, p < 0.001) and extracorporeal membrane oxygenation (27 vs. 5%, p = 0.009), and less likely to receive continuous renal replacement therapy (20 vs. 49%, p = 0.002) or have renal dysfunction (54 vs. 78%, p = 0.014) as compared with immunocompromised cases. Immunocompromised cases were more likely to have bacteremia (57 vs. 16%, p < 0.001) and adenoviremia (51 vs. 17%, p < 0.001) and be treated with antiviral medications (81 vs. 26%, p < 0.001). We observed a high burden of nonrespiratory organ system dysfunction in a cohort of pediatric case fatalities with adenoviral respiratory infection. The majority of cases had a chronic medical condition associated with an increased risk of complications from viral respiratory illness, most notably immunocompromised state. Important treatment differences were noted between immunocompromised and immunocompetent cases.
This is the first study to correlate averaged RSO(2) measured by cNIRS with neurological injury markers in critically ill children. We believe that this data can be used to establish thresholds for RSO(2) that can be tested in future trials to determine if this technology is predictive of long-term neurological outcome.
BackgroundNovel investigative tools (e.g., whole-genome sequencing) help characterize host and viral genetic contributions to disease severity in pediatric viral respiratory infection. However, a validated scoring system for quantifying illness severity is needed to properly contextualize results. Existing scoring systems are outdated, unvalidated and underpowered. We thus developed a scoring system to address these concerns.MethodsChildren hospitalized with viral respiratory infections were prospectively enrolled over 2 years, with 51 clinical variables abstracted from the medical record. 7 variables felt to be most predictive of disease severity and significantly correlated with each other (Spearman correlation coefficient P < 0.001) were included in the scoring system (duration of hospital and ICU stay, oxygen and high flow nasal cannula (HFNC) use and intubation; maximum nasal cannula and HFNC support), and combined into a disease severity index by converting each into an ordinal score and summing over the variables, with each variable sub-divided into 7 levels of exposure (based on equal interval length cutpoints). For a validation comparison, sampling algorithms utilizing a linear model selected a subset of 96 patients whose disease severity would be randomly assessed by 8 pediatricians in blocks of 12, using D-optimality and space filling criteria to protect against non-linearity (severity scored 1 to 10; 80% power for detection of correlation >0.28, two-sided α = 0.05). Mixed model regression analyses compared clinician-scored disease severity with the scoring system. Akaike Information criteria (AIC) and coefficients of determination (R2) ranked severity indices.Results445 subjects (56.2% male, median age 1.2 years) were enrolled. Clinician scores of disease severity averaged 6.2 (SD = 2.2, range 1–10). A scoring system using 7 variables with 7 levels of exposure per variable produced the lowest AIC (0.00, R2 = 0.70 for predicting clinician-scored disease severity after adjustment for rater effects) (Figure 1).ConclusionA 7-variable scoring system quantifying disease severity in pediatric viral respiratory infections correlates well with clinician assessment, and may advance the study of such infections.Figure 1: Fitted model: Association of Clinician Score and Severity Scoring System.Disclosures
All authors: No reported disclosures.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.