Pneumonia is one of the most common serious bacterial infections in children worldwide, an important case of childhood morbidity and mortality globally, and a frequent and costly cause of emergency department (ED) visits and hospitalizations. Physicians currently rely on subjective impressions of clinical appearance to make initial site-of-care decisions. Such subjective judgments tend to overestimate disease severity in children with pneumonia; such overestimates are associated with the decision to hospitalize patients at low risk.

There is currently no evidence-based, validated tool to assist physicians in making targeted site-of-care and management decisions for children with community-acquired pneumonia (CAP). An evidence-based clinical prediction rule for CAP severity in children would assist physicians to accurately risk stratify children with CAP in the ED and improve clinical decisions. The objective of this study is to develop a clinical prediction rule to accurately identify children with CAP who are at risk for low, moderate and severe disease.

This study will include children diagnosed with CAP at Emergency Departments across the globe. Most sites will be part of the Pediatric Emergency Research Networks (PERN). Together, the research networks participating in PERN have access to data from over 3 million pediatric ED presentations annually, and to more than 100 hospitals, in five of the six WHO regions. This study will enhance clinical care and future research by moving from use of subjective impressions that do not adequately predict outcomes in children with CAP toward an evidence-based approach.

Study design                              

Multi-centre prospective cohort study (global)

Timeframe

2018 – 2022

Funding

Unfunded

Sample

Approximately 5000 children with CAP (total from all sites), 3 months to <14 years

Contact                                               

Franz.babl@rch.org.au
Catherine.wilson@mcri.edu.au, or
PERN@cchmc.org

Clinical trials registration

To be confirmed.    

Publications to date

Xie J, Kuppermann N, Florin TA, et al. Impact of SARS-CoV-2 Infection on the Association Between Laboratory Tests and Severe Outcomes Among Hospitalized Children. Open Forum Infect Dis. 2023 Oct 3;10(10):ofad485. doi: 10.1093/ofid/ofad485. PMID: 37869403; PMCID: PMC10588618. [Link]

Sumner MW, Florin TA, Kuppermann N, et al; of the Pediatric Emergency Research Network PERN, Pediatric Emergency Research Canada PERC – COVID-19 Study Teams. Liver transaminase concentrations in children with acute SARS-CoV-2 infection. Clin Biochem. 2023 Aug;118:110588. doi: 10.1016/j.clinbiochem.2023.110588. Epub 2023 May 30. PMID: 37263559; PMCID: PMC10228160. [Link]

Funk AL, Kuppermann N, Florin TA, et al; Pediatric Emergency Research Network–COVID-19 Study Team. Post-COVID-19 Conditions Among Children 90 Days After SARS-CoV-2 Infection. JAMA Netw Open. 2022 Jul 1;5(7):e2223253. doi: 10.1001/jamanetworkopen.2022.23253. Erratum in: JAMA Netw Open. 2022 Aug 1;5(8):e2231131. PMID: 35867061; PMCID: PMC9308058. [Link]

Freedman SB, Kuppermann N, Funk AL, et al; Pediatric Emergency Research Network-COVID-19 Study Team. Corticosteroids and Other Treatments Administered to Children Tested for SARS-CoV-2 Infection in Emergency Departments. Acad Pediatr. 2022 Sep-Oct;22(7):1200-1211. doi: 10.1016/j.acap.2022.04.006. Epub 2022 Apr 22. PMID: 35462066; PMCID: PMC9023083. [Link]

Funk AL, Florin TA, Kuppermann N, et al; Pediatric Emergency Research Network-COVID-19 Study Team. Outcomes of SARS-CoV-2-Positive Youths Tested in Emergency Departments: The Global PERN-COVID-19 Study. JAMA Netw Open. 2022 Jan 4;5(1):e2142322. doi: 10.1001/jamanetworkopen.2021.42322. PMID: 35015063; PMCID: PMC8753506. [Link]

Funk AL, Florin TA, Dalziel SR, et al. Prospective cohort study of children with suspected SARS-CoV-2 infection presenting to paediatric emergency departments: a Paediatric Emergency Research Networks (PERN) Study Protocol. BMJ Open. 2021 Jan 15;11(1):e042121. doi: 10.1136/bmjopen-2020-042121. PMID: 33452195; PMCID: PMC7813043. [Link]

Florin TA, Tancredi DJ, Ambroggio L, et al; Pediatric Emergency Research Networks (PERN) Pneumonia Investigators. Predicting severe pneumonia in the emergency department: a global study of the Pediatric Emergency Research Networks (PERN)-study protocol. BMJ Open. 2020 Dec 2;10(12):e041093. doi: 10.1136/bmjopen-2020-041093. PMID: 33268423; PMCID: PMC7713188. [Link].

Craig S, Babl FE, Dalziel SR, Gray C, Powell C, Al Ansari K, Lyttle MD, Roland D, Benito J, Velasco R, Hoeffe J, Moldovan D, Thompson G, Schuh S, Zorc JJ, Kwok M, Mahajan P, Johnson MD, Sapien R, Khanna K, Rino P, Prego J, Yock A, Fernandes RM, Santhanam I, Cheema B, Ong G, Chong SL, Graudins A; Pediatric Emergency Research Networks (PERN).  Acute severe paediatric asthma: study protocol for the development of a core outcome set, a Pediatric Emergency Research Networks (PERN) study. Trials. 2020 Jan 13;21(1):72. doi: 10.1186/s13063-019-3785-6. [link]. 

Craig SS, Dalziel SR, Powell CV, Graudins A, Babl FE, Lunny C.  Interventions for escalation of therapy for acute exacerbations of asthma in children: an overview of Cochrane Reviews.  Cochrane Database Syst Rev. 2020 Aug 5;8:CD012977. doi: 10.1002/14651858.CD012977.pub2. PMID: 32767571 Review. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012977.pub2/full

Craig SS, Dalziel SR, Powell CVE, Graudins A, Babl FE, Lunny C. Interventions for escalation of therapy for acute exacerbations of asthma in children: An overview of Cochrane reviews. Paediatr Respir Rev. 2021 Jun;38:63-65. doi: 10.1016/j.prrv.2020.08.006. Epub 2020 Aug 20. PMID: 32952049. [Link]

Gray CS, Powell CVE, Babl FE, Dalziel SR, Craig S; PREDICT (Paediatric Research In Emergency Departments International Collaborative) Research Network. Variability of outcome measures in trials of intravenous therapy in acute severe paediatric asthma: a systematic review.  Emerg Med J. 2018 Nov 27. doi: 10.1136/emermed-2018-207929. [Epub ahead of print] [link]

Babl F. E., Sheriff N., Borland M., Acworth J., Neutze J., Krieser D., Ngo P., Schutz J., Thomson F., Cotterell E., Jamison S., and Francis P., ‘Paediatric Acute Asthma Management in Australia and New Zealand: Practice Patterns in the Context of Clinical Practice Guidelines’, Archives of Disease in Childhood, (2008) 93 (4), 307-12. [link]