NIH-funded research to develop pneumonia severity prediction tool to improve emergency care of children

Todd Florin, MD, MSCE, from Ann & Robert H. Lurie Children’s Hospital of Chicago recently was awarded a $5.8 million grant from the National Heart, Lung, and Blood Institute (NHLBI) for a multicenter study to derive and broadly validate the first emergency department (ED)-based pediatric community-acquired pneumonia severity (PedCAPS) score. This objective score will help avoid many unnecessary hospitalizations in children at low risk of severe outcomes, while targeting more focused therapies towards the lower proportion of children at highest risk for severe disease.

Although community-acquired pneumonia (CAP) is one of the most common serious infections in children and a leading reason that children seek emergency care, no validated tools exist to predict disease severity in children. CAP risk scores are commonly used in adults, improving hospitalization decisions and reducing unnecessary use of antibiotics.

“Without objective, evidence-based tools, pneumonia management decisions are inefficient and potentially inaccurate, resulting in unnecessary testing, treatment, and hospitalization in low-risk children or delays in critically important therapies in those at high risk of severe illness,” said Dr. Florin, Director of the Grainger Research Program in Pediatric Emergency Medicine at Lurie Children’s and Associate Professor of Pediatrics at Northwestern University Feinberg School of Medicine. “I feel great optimism that the PedCAPS score will improve health outcomes, quality of life, antimicrobial resistance, and resource utilization, in addition to ensuring equitable care, for children with this common pediatric infection.”

This study will leverage the robust infrastructure, experience, and expertise of the Pediatric Emergency Care Applied Research Network (PECARN). To derive the PedCAPS score, Dr. Florin and colleagues will enroll 2,000 children with CAP presenting to one of seven PECARN EDs over two years. They will then enroll 2,000 more children with CAP at seven different PECARN EDs over the following two years to externally validate the risk assessment tool. In addition, they will evaluate whether biomarkers, such as c-reactive protein, procalcitonin, proadrenomedullin, and viral detection, can improve predictive accuracy of a purely clinical risk prediction tool.

“PedCAPS will shift the paradigm of ED management of pneumonia in children, moving from subjective decisions toward a novel, objective approach where individualized, evidence-based risk estimates can augment and improve accuracy of clinical decision making,” said Dr. Florin.

Research at Ann & Robert H. Lurie Children’s Hospital of Chicago is conducted through Stanley Manne Children’s Research Institute. The Manne Research Institute is focused on improving child health, transforming pediatric medicine and ensuring healthier futures through the relentless pursuit of knowledge. Lurie Children’s is ranked as one of the nation’s top children’s hospitals by U.S. News & World Report. It is the pediatric training ground for Northwestern University Feinberg School of Medicine. Emergency medicine-focused research at Lurie Children’s is conducted through the Grainger Research Program in Pediatric Emergency Medicine.