Article: Tagarro A, Moraleda C, Domínguez-Rodríguez S, Rodríguez M, Martín MD, Herreros ML, Jensen J, López A, Galán JC, Otheo E; VALS-DANCE Study Group. A Tool to Distinguish Viral From Bacterial Pneumonia. Pediatr Infect Dis J. 2022 Jan 1;41(1):31-36. doi: 10.1097/INF.0000000000003340. PMID: 34524234.
Fellow: Monica Mattes, MD; Children’s Hospital Los Angeles
Summary: The authors conducted a multi-center prospective cohort study that included 262 children aged 1 month-16 years old admitted at 24 different hospitals with an aim to build and validate a diagnostic tool for patients with community-acquired pneumonia (CAP) that combined clinical, analytical, and radiographic features. A scoring system with 2 sequential steps was built: step 1 differentiates viral from bacterial CAP; step 2 distinguishes typical from atypical bacterial CAP.
Key Strengths: The study included a large population across multiple hospitals in Spain, and also included younger patients down to 1 month old. They had two physicians review the chest radiographs to confirm presence of a consolidation as part of study eligibility. An extensive microbiologic workup was done including blood cultures, bacterial PCR, and viral nasopharyngeal PCR, as well as using two paired samples taken weeks apart for atypical bacteria identification. The authors were able to build a clinical prediction rule with high sensitivity that was validated prospectively and also incorporated into a decision support tool mobile app.
Limitations/Flaws: The scores on the validated tool have low specificity, due to the prioritization of sensitivity over specificity. The authors did not perform an impact analysis, so it remains unknown if the use of their tool will change behavior or improve outcomes. Additionally, the authors only did a narrow validation and excluded patients with any chronic cardiac or pulmonary disease (aside from asthma). Lastly, there is no reliable standard for diagnosing the etiology of CAP, so some patients may have been classified incorrectly.
Takeaway Message: A validated decision tool can be used to help guide clinical management for hospitalized children with CAP. Providers can use a 2-step tool that incorporates clinical, analytical, and radiographic features to help distinguish between the various CAP etiologies (viral, typical, and atypical bacteria).
Practice Impact: This clinical tool can potentially help to improve appropriate antibiotic usage in CAP, in an otherwise challenging clinical situation. When approaching the decision to start antibiotics in a hospitalized patient, and if so which antibiotics, referencing this decision tool may help to guide management.
Fellow: Monica Mattes, MD; Children’s Hospital Los Angeles
Summary: The authors conducted a multi-center prospective cohort study that included 262 children aged 1 month-16 years old admitted at 24 different hospitals with an aim to build and validate a diagnostic tool for patients with community-acquired pneumonia (CAP) that combined clinical, analytical, and radiographic features. A scoring system with 2 sequential steps was built: step 1 differentiates viral from bacterial CAP; step 2 distinguishes typical from atypical bacterial CAP.
Key Strengths: The study included a large population across multiple hospitals in Spain, and also included younger patients down to 1 month old. They had two physicians review the chest radiographs to confirm presence of a consolidation as part of study eligibility. An extensive microbiologic workup was done including blood cultures, bacterial PCR, and viral nasopharyngeal PCR, as well as using two paired samples taken weeks apart for atypical bacteria identification. The authors were able to build a clinical prediction rule with high sensitivity that was validated prospectively and also incorporated into a decision support tool mobile app.
Limitations/Flaws: The scores on the validated tool have low specificity, due to the prioritization of sensitivity over specificity. The authors did not perform an impact analysis, so it remains unknown if the use of their tool will change behavior or improve outcomes. Additionally, the authors only did a narrow validation and excluded patients with any chronic cardiac or pulmonary disease (aside from asthma). Lastly, there is no reliable standard for diagnosing the etiology of CAP, so some patients may have been classified incorrectly.
Takeaway Message: A validated decision tool can be used to help guide clinical management for hospitalized children with CAP. Providers can use a 2-step tool that incorporates clinical, analytical, and radiographic features to help distinguish between the various CAP etiologies (viral, typical, and atypical bacteria).
Practice Impact: This clinical tool can potentially help to improve appropriate antibiotic usage in CAP, in an otherwise challenging clinical situation. When approaching the decision to start antibiotics in a hospitalized patient, and if so which antibiotics, referencing this decision tool may help to guide management.