Criteria

Severity criteria (US national guideline)[1]

According to the Pediatric Infectious Diseases Society/Infectious Diseases Society of America (PIDS/IDSA) guideline, paediatric CAP is defined as moderate-to-severe (and warrants hospital admission) if any of the following features are present:[1]

  • Sustained peripheral oxygen saturation <90% on room air. This has been shown to be predictive of failure of outpatient oral antibiotic treatment.

  • Any one or more of the following signs of respiratory distress:

    • Tachypnoea: respiratory rate (breaths/minute) of >60 at age 0-2 months; >50 at age 2-12 months; >40 at age 1-5 years; >20 at age >5 years.

    • Dyspnoea.

    • Suprasternal, intercostal, or subcostal retractions, indicating increased work of breathing.

    • Grunting - a sign of impending respiratory failure.

    • Nasal flaring or head bobbing.

    • Apnoea.

    • Cyanosis - a sign of severe hypoxaemia.

    • Altered mental status.

Severity criteria (British Thoracic Society [BTS] guideline)[9]

The BTS defines severe CAP according to the presence of one of more of the following:[9]

  • Oxygen saturation <92%.

  • Temperature >38.5°C (>101.3°F).

  • Significant tachypnoea: respiratory rate >70 breaths/minute in infants or >50 breaths/minute in older children.

  • Moderate to severe chest recession (more common in infants) or severe difficulty in breathing (more common in older children).

  • Nasal flaring, grunting, or intermittent apnoea.

  • Cyanosis.

  • Significant tachycardia according to age-related parameters.

  • Capillary refill time (CRT) ≥2 seconds.

  • Not feeding (infant) or signs of dehydration.

Severity criteria (UK National Institute for Health and Care Excellence [NICE])[18]

NICE lists the following as features of severe CAP:[18]

  • Difficulty breathing

  • Oxygen saturation <90%

  • Raised heart rate

  • Grunting

  • Very severe chest indrawing

  • Inability to drink or breastfeed

  • Lethargy or reduced level of consciousness.

Severity criteria (World Health Organization [WHO])[52]

In resource-limited countries, CAP is defined by the WHO as fast breathing and/or chest indrawing in a child aged 2-59 months who presents with cough and/or difficulty breathing.[29]

Children are considered to have severe pneumonia, and hospitalisation is recommended, if any one or more of the following general danger signs is present:[52]

  • Unable to drink

  • Persistent vomiting

  • Convulsions

  • Lethargic or unconscious

  • Stridor

  • Severe malnutrition.

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