Jakhar et al identified risk factors for a poor outcome in a young child with severe pneumonia. These can help to identify a patient who may benefit from more aggressive management. The authors are from University College of Medical Sciences & GTB Hospital in Delhi.

Patient selection: child from 2 months to 5 years of age with severe pneumonia


Common pathogens: Streptococcus pneumoniae, Staphylococcus aureus


Poor outcome: treatment failure, need to change antibiotics, prolonged hospital stay, need for mechanical ventilation, death


Risk factors for a poor outcome:

(1) respiratory rate > 70 breaths per minute

(2) altered mental status (lethargy to coma)

(3) positive blood culture

(4) inability to drink

(5) abnormal chest X-ray

(6) rickets


Other factors:

(1) a history of low birth weight

(2) overcrowding

(3) crepitation

(4) leukocytosis


The presence of a wheeze was associated with a better outcome.

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