Validation and comparison of two pneumonia severity criteria: A cross-sectional study of paediatric community-acquired pneumonia in Indonesia

Abstract

Background : Community-acquired pneumonia (CAP) is a major cause of paediatric morbidity and hospitalization. Early identification of severe disease is essential for appropriate management. Several severity assessment tools, including the British Thoracic Society (BTS) and Paediatric Infectious Diseases Society/Infectious Diseases Society of America (PIDS/IDSA) criteria, are used to identify severe CAP in children, but their diagnostic performance varies. This study aimed to evaluate and compare the ability of the BTS and PIDS/IDSA severity scores to identify severe CAP in children.

Methods: Data were collected from medical records of hospitalized children (0-18 years) with radiologically confirmed pneumonia from December 2015 to December 2019. Demographic, clinical, and laboratory data were gathered, and severe pneumonia was classified using World Health Organization (WHO), BTS, and PIDS/IDSA criteria. Diagnostic performance was evaluated through sensitivity, specificity, predictive values, and ROC curve analysis.

Results: A total of 217 participants were included, with 100 cases (46%) meeting WHO criteria for severe pneumonia. The PIDS criteria had a higher sensitivity (72%) for predicting severe pneumonia, whereas the BTS criteria had a higher specificity (92.3%). The BTS criteria showed a positive predictive value (PPV) of 81.6%, a negative predictive value (NPV) of 64.3%, and an area under the curve (AUC) of 0.66. In comparison, the PIDS criteria had a PPV of 49.7%, NPV of 61.1%, and an AUC of 0.54.

Conclusion: The PIDS criteria showed a higher sensitivity but had lower specificity and discrimination, whereas the BTS criteria had high specificity and low sensitivity.  Additional  studies are needed to improve and validate these criteria.