Abstract
Background: Pneumonia is the leading cause of paediatric admission and antibiotic use in Vietnam. There is a need for better prediction of ‘unlikely bacterial pneumonia’ to guide rational antibiotic use, and ‘adverse pneumonia outcome’ to improve hospital care.
Methods: We prospectively collected data on all children <5 admitted with ‘pneumonia’ (per clinician assessment) to a provincial hospital in central Vietnam. We assessed children classified as ‘no pneumonia’ (not meeting WHO pneumonia criteria with normal chest radiograph) and ‘likely viral pneumonia’ (meeting WHO pneumonia criteria with CRP <10mg/L) compared to those with ‘likely bacterial pneumonia’ (meeting WHO pneumonia criteria with CRP ≥50mg/L), and evaluated predictors of ‘adverse pneumonia outcome’ (death or ICU admission).
Results: Of 3,817 patients assessed, 984 (25.8%) were classified as ‘no pneumonia’, 305 (8.0%) as ‘likely viral’ and 129 (3.4%) as ‘likely bacterial’ pneumonia. The presence of wheeze or runny nose, the absence of consolidation on chest radiograph and a neutrophil count <5x109/L reliably identified children with ‘unlikely bacterial pneumonia’; negative predictive value of 0.98. An adverse outcome was documented in 189/2,199 (8.6%) children who met WHO pneumonia criteria. The presence of any WHO danger sign or peripheral oxygen saturation <90%, chest radiograph consolidation, a neutrophil count ≥10x109/L and low birth weight (<2500g; especially in children under 2) offered the best prediction value.
Conclusion: Careful assessment of relevant clinical symptoms and signs can be used to guide rational antibiotic use and reduce unnecessary hospitalisation in Vietnam; further verification is required to establish safety.
Footnotes
Cite this article as: European Respiratory Journal 2019; 54: Suppl. 63, PA1041.
This is an ERS International Congress abstract. No full-text version is available. Further material to accompany this abstract may be available at www.ers-education.org (ERS member access only).
- Copyright ©the authors 2019