Language

English

Publication Date

5-1-2026

Journal

Journal of Hospital Medicine

DOI

10.1002/jhm.70220

PMID

41272952

PMCID

PMC12781122

PubMedCentral® Posted Date

11-21-2025

PubMedCentral® Full Text Version

Post-print

Abstract

Introduction: Community-acquired pneumonia (CAP) is a frequent and costly cause of pediatric emergency department (ED) visits and hospitalizations. Previous prognostic tools for CAP are limited by small samples, single-center or retrospective designs, lack of generalizability to ED settings, lack of biomarkers, or limited objective data. To overcome these limitations, we will derive and externally validate a prediction rule for pediatric CAP severity in a large, multicenter prospective cohort.

Methods: This is a prospective cohort study of children 3 months to 18 years old with CAP who present to EDs within the Pediatric Emergency Care Applied Research Network. Enrollment began 8/2023 and will end 7/2027. We exclude children with recent hospitalizations and chronic conditions (e.g., immunosuppression). A follow-up survey and record review is completed 8-15 days after the visit. Blood and nasal specimens are obtained to evaluate the role of C-reactive protein, procalcitonin, proadrenomedullin, and viral detection in severity prediction. The primary outcome is severity (three-tiered outcome of mild, moderate, or severe CAP) within 7 days of ED presentation. Model derivation will occur in ~4000 children from 7 EDs over 2 years. External validation will occur in a distinct cohort of at least 2000 children from 7 different EDs. Penalized regression, recursive partitioning, and machine learning will be used in model development.

Discussion: At study completion, we will have a validated CAP severity prediction rule well-positioned for implementation and further evaluation. We will also understand the role of specific biomarkers in predicting outcomes in children with CAP.

Keywords

Humans, Community-Acquired Infections, Child, Prospective Studies, Severity of Illness Index, Child, Preschool, Pneumonia, Infant, Adolescent, Male, Female, Biomarkers, Emergency Service, Hospital, C-Reactive Protein, Community-Acquired Pneumonia

Published Open-Access

yes

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