II. Indications
-
Pneumonia severity evaluation in children
- Directs disposition (Inpatient, PICU)
III. Signs: Respiratory Distress in Pneumonia
-
Tachypnea
- See Tachypnea for age-related criteria
- Dyspnea
- Apnea
- Altered Mental Status
- Increased work of breathing
- Retractions
- Suprasternal retractions (neck)
- Intercostal retractions
- Subcostal retractions (abdominal)
- Grunting
- Nasal flaring
- Retractions
-
Hypoxemia
- Pulse Oximetry <90% on room air
- PaO2 to FIO2 ratio <250
IV. Evaluation: Severity
- Used to determine disposition (regular inpatient ward or pediatric Intensive Care)
- Major Criteria
- Invasive Mechanical Ventilation
- Shock refractory to fluid Resuscitation
- Noninvasive Positive Pressure Ventilation (NIPPV) acutely needed
- Hypoxemia refractory to Supplemental Oxygen FIO2 50% with Oxygen Saturation <92%
- Minor Criteria
- See Respiratory Distress signs above
- Multilobar infiltrates
- Pedaitric Early Warning Score (PEWS Score) >6
- Hypotension
- Pleural Effusion
- Unexplained Metabolic Acidosis
- Serious comorbidity
- Sickle Cell Anemia (Hemoglobin SS Disease)
- Immunodeficiency
- Interpretation: Indication for PICU admission
- One major criteria or two minor criteria