II. Indications

  1. Pneumonia severity evaluation in children
    1. Directs disposition (Inpatient, PICU)

III. Signs: Respiratory Distress in Pneumonia

  1. Tachypnea
    1. See Tachypnea for age-related criteria
  2. Dyspnea
  3. Apnea
  4. Altered Mental Status
  5. Increased work of breathing
    1. Retractions
      1. Suprasternal retractions (neck)
      2. Intercostal retractions
      3. Subcostal retractions (abdominal)
    2. Grunting
    3. Nasal flaring
  6. Hypoxemia
    1. Pulse Oximetry <90% on room air
    2. PaO2 to FIO2 ratio <250

IV. Evaluation: Severity

  1. Used to determine disposition (regular inpatient ward or pediatric intensive care)
  2. Major Criteria
    1. Invasive Mechanical Ventilation
    2. Shock refractory to fluid Resuscitation
    3. Noninvasive Positive Pressure Ventilation (NIPPV) acutely needed
    4. Hypoxemia refractory to Supplemental Oxygen FIO2 50% with Oxygen Saturation <92%
  3. Minor Criteria
    1. See Respiratory Distress signs above
    2. Multilobar infiltrates
    3. Pedaitric Early Warning Score (PEWS Score) >6
    4. Hypotension
    5. Pleural Effusion
    6. Unexplained Metabolic Acidosis
    7. Serious comorbidity
      1. Sickle Cell Anemia (Hemoglobin SS Disease)
      2. Immunodeficiency
  4. Interpretation: Indication for PICU admission
    1. One major criteria or two minor criteria

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