Validation of the Pediatric Infectious Diseases Society-Infectious Diseases Society of America Severity Criteria in Children With Community-Acquired Pneumonia

Clin Infect Dis. 2018 Jun 18;67(1):112-119. doi: 10.1093/cid/ciy031.


Background: The Pediatric Infectious Diseases Society (PIDS)-Infectious Diseases Society of America (IDSA) guideline for community-acquired pneumonia (CAP) recommends intensive care unit (ICU) admission or continuous monitoring for children meeting severity criteria. Our objective was to validate these criteria.

Methods: This was a retrospective cohort study of children aged 3 months-18 years diagnosed with CAP in a pediatric emergency department (ED) from September 2014 through August 2015. Children with chronic conditions and recent ED visits were excluded. The primary predictor was the PIDS-IDSA severity criteria. Outcomes included disposition, and interventions and diagnoses that necessitated hospitalization (ie, need for hospitalization [NFH]).

Results: Of 518 children, 56.6% were discharged; 54.3% of discharged patients and 80.8% of those hospitalized for less than 24 hours were classified as severe. Of those admitted, 10.7% did not meet severity criteria; 69.5% met PIDS-IDSA severity criteria. Of those children, 73.1% did not demonstrate NFH. The areas under the receiver operator characteristic curves (AUC) for PIDS-IDSA major criteria were 0.63 and 0.51 for predicting disposition and NFH, respectively. For PIDS-IDSA minor criteria, the AUC was 0.81 and 0.56 for predicting disposition and NFH, respectively. The sensitivity, specificity, and likelihood ratios (LR)+ and LR- of the PIDS-IDSA criteria were 89%, 46%, 1.65, and 0.23 for disposition and 95%, 16%, 1.13, and 0.31 for NFH.

Conclusions: More than half of children classified as severe by PIDS-IDSA criteria were not hospitalized. The PIDS-IDSA CAP severity criteria have only fair ability to predict the need for hospitalization. New predictive tools specifically for children are required to improve clinical decision making.

Publication types

  • Research Support, N.I.H., Extramural
  • Validation Study

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Clinical Decision-Making
  • Community-Acquired Infections / diagnosis*
  • Emergency Medicine
  • Female
  • Hospitalization / statistics & numerical data
  • Hospitals, Pediatric / statistics & numerical data
  • Humans
  • Infant
  • Infectious Disease Medicine
  • Male
  • Pediatrics / methods
  • Pneumonia / classification
  • Pneumonia / diagnosis*
  • Practice Guidelines as Topic*
  • ROC Curve
  • Retrospective Studies
  • Severity of Illness Index*
  • Societies, Medical
  • United States