WHO WILL REQUIRE ADMISSION?

KEY RECOMMENDATION

A patient who is at moderate to high risk to

1 develop pneumonia-related mortality should
be admitted [Grade D].

A patient who is at minimal to low risk can be

2 managed on an outpatient basis [Grade D].
 WHO WILL REQUIRE ADMISSION?

RISK CLASSIFICATION FOR PNEUMONIA-RELATED MORTALITY

 WHO WILL REQUIRE ADMISSION?
RISK CLASSIFICATION FOR PNEUMONIA-RELATED MORTALITY
WHO WILL REQUIRE ADMISSION?

SUMMARY OF EVIDENCE
1 2
Host factors External factors

a. Ability to feed a. Compliant caregiver

b. Age b. Ability to follow-up
c. Signs of respiratory failure
d. Pulmonary complications
e. Respiratory rate
f. State of dehydration
g. Presence of comorbid
factors
WHO WILL REQUIRE ADMISSION?

Compared with older children, an infant

younger than 1 year has a higher risk of
contracting severe pneumonia

Age from 2 to 11 months was associated

with death
 WHO WILL REQUIRE ADMISSION?
Presence of retractions

Best single predictor of death associated with a

23-fold higher odds of mortality

Presence of tachypnea, chest retraction, somnolence, young age,

malnutrition, underlying chronic illness

Independently associated with hospitalization

 WHO WILL REQUIRE ADMISSION?

Inability to cry, head nodding, respiratory rate

>60/min

Best predictors of hypoxemia

WHAT DIAGNOSTIC AIDS ARE INITIALLY REQUESTED
FOR A PATIENT CLASSIFIED AS EITHER PCAP A OR
PCAP B BEING MANAGED IN AN AMBULATORY
SETTING?
KEY RECOMMENDATION

No diagnostic aids are initially requested for a

patient classified as either PCAP A or PCAP B
who is being managed in an ambulatory setting
[Grade D].
WHAT DIAGNOSTIC AIDS ARE INITIALLY REQUESTED
FOR A PATIENT CLASSIFIED AS EITHER PCAP C OR
PCAP D BEING MANAGED IN A HOSPITAL SETTING?
KEY RECOMMENDATION
1. The following should be routinely requested:
a. Chest x-ray PA-lateral [Grade B].
b. White blood cell count [Grade C].
c. Culture and sensitivity of
Blood for PCAP D [Grade D]
Pleural fluid [Grade D]
Tracheal aspirate upon initial intubation [Grade D]
Blood gas and/or pulse oximetry [Grade D]
2. The following may be requested:
Culture and sensitivity of sputum for older children [Grade D].
3. The following should not be routinely requested:
a. Erythrocyte sedimentation rate [Grade A]
b. C- reactive protein [Grade A]
WHAT DIAGNOSTIC AIDS ARE INITIALLY REQUESTED
FOR A PATIENT CLASSIFIED AS EITHER PCAP C OR
PCAP D BEING MANAGED IN A HOSPITAL SETTING?
KEY RECOMMENDATION
Chest x-ray PA-lateral

Alveolar consolidation is sensitive for a bacterial or bacterial-

viral etiology varying from 42% to 75%
1. Stronger basis for stratification of risks of pneumonia-
related mortality.

2. Therapeutic intervention.
WHAT DIAGNOSTIC AIDS ARE INITIALLY REQUESTED
FOR A PATIENT CLASSIFIED AS EITHER PCAP C OR
PCAP D BEING MANAGED IN A HOSPITAL SETTING?
KEY RECOMMENDATION
White Cell Count

Bacterial cause among hospitalized patients generally

increases as white blood cell counts increase above 15, 000
WHAT DIAGNOSTIC AIDS ARE INITIALLY REQUESTED
FOR A PATIENT CLASSIFIED AS EITHER PCAP C OR
PCAP D BEING MANAGED IN A HOSPITAL SETTING?
KEY RECOMMENDATION
Microbiology

Blood culture and sensitivity should be routinely

requested among patients classified as PCAP D
WHAT DIAGNOSTIC AIDS ARE INITIALLY REQUESTED
FOR A PATIENT CLASSIFIED AS EITHER PCAP C OR
PCAP D BEING MANAGED IN A HOSPITAL SETTING?
KEY RECOMMENDATION
Oxygen saturation and or blood gas
To assess gas exchange for all patients being
considered for admission