Risk factors and clinical outcomes of severe community-acquired pneumonia classified by CPS-ped scale in children under 5 years

Abstract

Background: Pneumonia remains a leading cause of mortality in children under 5 years of age. Severe pneumonia impairs gas exchange, causing hypoxia, which leads to type 1 acute respiratory failure. Identifying clinical risk factors associated with disease severity could be beneficial for surveillance and treatment planning.

Objectives: To investigate the clinical risk factors associated with severe community-acquired pneumonia (CAP) and the treatment outcomes in hospitalized pediatric patients under 5 years of age.

Methods: This prognostic factor study used a retrospective design was conducted at the Department of Pediatrics, Mukdahan Hospital. Data were extracted from the inpatient medical records of pediatric patients diagnosed with CAP who were admitted between October 2023 and September 2024 and identified by the primary ICD-10 diagnostic codes (J12–J18). The Clinical Progression Scale for Pediatric Patients (CPS-ped) was used to classify severity: The severe group was defined as CPS-ped ≥ 4, and the non-severe group as CPS-ped < 4. Factors between the two groups were compared using the exact probability test. Risk factors were analyzed using multivariable logistic regression and reported as adjusted odds ratios (aOR).

Results: Of the 236 medical records reviewed, 50.0% were female, with a mean age of 27.3±15.7 months. Sixty-seven patients (28.4%) were classified as having severe pneumonia. The identified risk factors for severe pneumonia included age under 18 months (aOR 3.04, 95% CI 1.22–7.56; p value 0.017), respiratory rate exceeding age-adjusted range (aOR 8.79, 95% CI 3.21–24.05; p value < 0.001), abnormal lung sounds (aOR 4.30, 95% CI 1.54–12.02; p value < 0.001), use of accessory muscles for breathing (aOR 7.55, 95% CI 2.61–21.88; p-value < 0.001), and oxygen saturation below 95% (aOR 4.45, 95% CI 1.76–11.25; p value 0.002). Regarding treatment outcomes, the severe pneumonia group had a mean length of hospital stay of 5.1±3.0 days, with 2 deaths (3.0%). In contrast, the non-severe group had a mean length of stay of 3.4±1.8 days, with no mortalities.

Conclusions: Risk factors for severe CAP in children under 5 years old included age under 18 months, respiratory rate exceeding age-adjusted range, abnormal lung sounds, use of accessory muscles for breathing, and oxygen saturation below 95%. The mortality rate in the severe group was 3.0%. These clinical indicators might assist physicians in screening patients who required respiratory support.