Predictors of Severe Outcomes in Children Hospitalised with Community-Acquired Pneumonia: A Prospective Observational Study from a Tertiary Care Centre in Bengaluru

Abstract

Background. Community-acquired pneumonia (CAP) remains a leading cause of hospitalisation and death among Indian children. Readily available bedside predictors of a severe in-hospital course are still incompletely defined in medium-volume tertiary paediatric units in South India.

Objective. To determine the frequency of severe in-hospital outcomes and to identify clinical, nutritional, and radiographic predictors among children hospitalised with CAP.

Methods. Consecutive children aged 2 months to 12 years admitted with World Health Organization (WHO)–defined CAP to the Department of Paediatrics, Sapthagiri Institute of Medical Sciences and Research Centre, Bengaluru, were enrolled over 12 months. The primary endpoint was a composite severe outcome: paediatric intensive care unit (PICU) admission, non-invasive or invasive ventilation, hospital stay ≥7 days, pneumonia complication, or in-hospital death. Associations were examined with χ² or Fisher exact tests and binary logistic regression.

Results. Of 78 children screened, 56 were analysed (mean age 28.4 ± 22.1 months; 34 boys, 60.7%). A severe outcome occurred in 18 children (32.1%), including two deaths (3.6%). Independent unadjusted associations included WHO danger signs (odds ratio [OR] 13.36; 95% confidence interval [CI] 3.28–54.39), hypoxaemia with SpO₂ <92% (OR 8.86; 2.47–31.79), abnormal chest radiograph (OR 5.82; 1.17–28.96), age <12 months (OR 4.69; 1.39–15.77), incomplete immunisation, lack of exclusive breastfeeding, and underweight (weight-for-age z-score [WAZ] < −2). In a three-variable model limited by event count, danger signs (adjusted OR [aOR] 8.12; 1.62–40.71) and hypoxaemia (aOR 5.94; 1.28–27.52) remained independent.

Conclusion. About one in three hospitalised children with CAP had a severe course. Pulse-oximetry hypoxaemia and WHO danger signs at admission should trigger PICU-level monitoring, even in a modest-volume tertiary ward.