Criteria
Severity criteria (US national guideline)[1]
According to the Pediatric Infectious Diseases Society/Infectious Diseases Society of America (PIDS/IDSA) guideline, pediatric 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:
Tachypnea: 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.
Dyspnea.
Suprasternal, intercostal, or subcostal retractions, indicating increased work of breathing.
Grunting - a sign of impending respiratory failure.
Nasal flaring or head bobbing.
Apnea.
Cyanosis - a sign of severe hypoxemia.
Altered mental status.
Severity criteria (World Health Organization [WHO])[51]
In resource-limited countries, CAP is defined by the WHO as fast breathing and/or chest indrawing in a child ages 2-59 months who presents with cough and/or difficulty breathing.[28]
Children are considered to have severe pneumonia, and hospitalization is recommended, if any one or more of the following general danger signs is present:[51]
Unable to drink
Persistent vomiting
Convulsions
Lethargic or unconscious
Stridor
Severe malnutrition.
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