Radiographic pneumonia in young febrile infants presenting to the emergency department: secondary analysis of a prospective cohort study.
Radiographic pneumonia in young febrile infants presenting to the emergency department: secondary analysis of a prospective cohort study.
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急诊科就诊的小发热婴儿的放射学肺炎：前瞻性队列研究的二次分析。
DOI：
10.1136/emermed-2023-213089
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发表时间：
2023
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Co
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作者：
Florin,ToddA;Ramilo,Octavio;Banks,RussellK;Schnadower,David;Quayle,KimberlyS;Powell,ElizabethC;Pickett,MichelleL;Nigrovic,LiseE;Mistry,Rakesh;Leetch,AaronN;Hickey,RobertW;Glissmeyer,EricW;Dayan,PeterS;Cruz,AndreaT;Co
目的缺乏循证标准来指导低龄发热婴儿胸部 X 光检查 (CXR) 的使用，导致其使用存在差异，从而导致护理质量不理想。我们试图描述与年幼发热婴儿放射学肺炎相关的特征。研究设计对 2016 年至 2019 年儿科急诊应用研究网络 18 个急诊科 (ED) 进行的前瞻性队列研究进行二次分析。纳入了接受 CXR 的年龄≤60 天的发热（≥38°C）婴儿。 CXR 报告被分为“无”、“可能”或“确诊”肺炎。我们比较了患有和不患有肺炎的婴儿的人口统计学、临床体征和实验室检查。结果 在 2612 名婴儿中，568 名（21.7%）进行了 CXR；其中19 人 (3.3%) 确诊为肺炎，34 人 (6%) 可能患有肺炎。与没有肺炎的患者（77/515，15.0%）相比，确诊（4/19，21.1%）或可能（11/34，32.4%）肺炎的患者更常出现呼吸窘迫（调整后 OR 2.17；95% CI 1.04 至 4.51）。患有和不患有放射学肺炎的婴儿的体温或心率没有差异。确诊组的中位血清降钙素原 (PCT) 水平 (0.7 ng/mL (IQR 0.1, 1.5)) 与非肺炎组 (0.1 ng/mL (IQR 0.1, 0.3)) 相比较高，中性粒细胞绝对计数 (ANC) 中位值也较高（确诊组为 5.8 K/mcL (IQR 3.9, 6.9) 与非肺炎组相比，为 3.1 K/mcL（IQR 1.9、5.3））。患有肺炎的婴儿没有出现菌血症。病毒检测频繁（无肺炎（309/422，73.2%），明确肺炎（11/16，68.8%），可能肺炎（25/29，86.2%））。肺炎组以呼吸道合胞病毒为主，非肺炎组以鼻病毒为主。结论发热婴儿放射学肺炎不常见。病毒检测很常见。肺炎与呼吸窘迫有关，但与其他因素无关。尽管确诊肺炎的婴儿 ANC 和 PCT 水平升高，但仍需进一步开展工作来评估血液生物标志物在婴儿肺炎中的作用。
ObjectiveThe lack of evidence-based criteria to guide chest radiograph (CXR) use in young febrile infants results in variation in its use with resultant suboptimal quality of care. We sought to describe the features associated with radiographic pneumonias in young febrile infants.Study designSecondary analysis of a prospective cohort study in 18 emergency departments (EDs) in the Pediatric Emergency Care Applied Research Network from 2016 to 2019. Febrile (≥38°C) infants aged ≤60 days who received CXRs were included. CXR reports were categorised as ‘no’, ‘possible’ or ‘definite’ pneumonia. We compared demographics, clinical signs and laboratory tests among infants with and without pneumonias.ResultsOf 2612 infants, 568 (21.7%) had CXRs performed; 19 (3.3%) had definite and 34 (6%) had possible pneumonias. Patients with definite (4/19, 21.1%) or possible (11/34, 32.4%) pneumonias more frequently presented with respiratory distress compared with those without (77/515, 15.0%) pneumonias (adjusted OR 2.17; 95% CI 1.04 to 4.51). There were no differences in temperature or HR in infants with and without radiographic pneumonias. The median serum procalcitonin (PCT) level was higher in the definite (0.7 ng/mL (IQR 0.1, 1.5)) vs no pneumonia (0.1 ng/mL (IQR 0.1, 0.3)) groups, as was the median absolute neutrophil count (ANC) (definite, 5.8 K/mcL (IQR 3.9, 6.9) vs no pneumonia, 3.1 K/mcL (IQR 1.9, 5.3)). No infants with pneumonia had bacteraemia. Viral detection was frequent (no pneumonia (309/422, 73.2%), definite pneumonia (11/16, 68.8%), possible pneumonia (25/29, 86.2%)). Respiratory syncytial virus was the predominant pathogen in the pneumonia groups and rhinovirus in infants without pneumonias.ConclusionsRadiographic pneumonias were uncommon in febrile infants. Viral detection was common. Pneumonia was associated with respiratory distress, but few other factors. Although ANC and PCT levels were elevated in infants with definite pneumonias, further work is necessary to evaluate the role of blood biomarkers in infant pneumonias.