Development and Validation of a Risk Score for Predicting Hospitalization in Children With Influenza Virus Infection
Development and Validation of a Risk Score for Predicting Hospitalization in Children With Influenza Virus Infection
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DOI：
10.1097/pec.0b013e3181a792a9
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发表时间：
2009-06-01
影响因子：
1.4
通讯作者：
Srivastava, Rajendu
中科院分区：
文献类型：
--
作者：
Bender, Jeffrey M.;Ampofo, Krow;Srivastava, Rajendu
目的：流感病毒感染导致儿童显着发病并经常导致住院。在季节性流感流行期间，许多患有流感的儿童在紧急情况下寻求治疗。我们假设某些特征可以预测流感儿童住院的需要。方法：对 2001 年 7 月至 2004 年 6 月期间在儿童医院收治的实验室确诊流感感染的所有 18 岁或以下儿童进行回顾性队列研究。对确诊流感病毒感染儿童的医疗记录进行了审查。使用逻辑回归模型确定了入院的预测因素。基于 4 个预测因子创建并验证了流感风险评分系统。结果：我们确定了 1230 名经实验室证实感染流感病毒的儿童。 541人住院。多变量逻辑回归表明，4 个预测因子与住院治疗独立密切相关。在流感住院儿童的临床预测规则中，高危疾病史（比值比 [OR]，4.06；95% 置信区间 [CI]，2.91-5.68）值得 2 分。呼吸窘迫油体格检查（OR，2.33；95% CI，1.61-3.38）得1分。局灶性肺炎的影像学证据（OR，7.82；95% CI，3.62-16.92）得分为 3 分，乙型流感感染（OR，3.99；95% CI，2.57-6.21）得分为 2 分。总风险评分为 3 至 8 分的流感高危儿童住院的可能性均为 86%。结论：存在高危医疗状况、体检时出现呼吸窘迫、局灶性肺炎的影像学证据和乙型流感感染是住院的 4 个最强预测因素。分配给患有流感的儿童的风险评分可以为预测季节性流感流行中儿童的住院情况提供处置工具。
Objective: Influenza virus infections cause significant morbidity and often result in hospitalization in children, Many children with influenza seek care in emergency settings during seasonal influenza epidemics. We hypothesized that certain features Could predict the need for hospitalization in children with influenza.Methods: Retrospective cohort study of all children 18 years or younger seen at a children's hospital with laboratory-confirmed influenza infection between July 2001 and June 2004. Medical records of children with confirmed influenza Virus infection were reviewed. Predictors of admission were identified using logistic regression models. An influenza risk score system was created and validated based on 4 predictors,Results: We identified 1230 children with laboratory proven influenza virus infection. 541 were hospitalized. Multivariate logistic regression demonstrated that 4 predictors were independently strongly associated with hospitalization. In the clinical prediction rule for children with influenza who were hospitalized, history of a high-risk medical condition (odds ratio [OR], 4.06; 95% confidence interval [CI], 2.91-5.68) was worth 2 points. Respiratory distress oil physical examination (OR, 2,33; 95% CI, 1.61-3.38) was worth 1 point. Radiographic evidence of focal pneumonia (OR, 7.82; 95% CI, 3.62-16.92) was worth 3 points and influenza B infection (OR, 3.99; 95% CI, 2.57-6.21) was worth 2 points. High-risk children with influenza with a total risk score of 3 to 8 had all 86% probability of hospitalization.Conclusions: The presence of a high-risk medical condition, respiratory distress on physical examination, radiographic evidence of focal pneumonia, and influenza B infection were the 4 strongest predictors of hospitalization. The risk score assigned to a child with influenza may provide a disposition tool for predicting hospitalization in children in seasonal influenza epidemics.