Table 1.

Pediatric Infectious Diseases Society–Infectious Diseases Society of America Pediatric Community-Acquired Pneumonia Severity Criteria [6]

Major Criteria
Invasive mechanical ventilation
Fluid refractory shocka
Acute need for NIPPVb
Hypoxemia requiring FiO2 greater than inspired concentration or flow feasible in general care areac
Minor Criteria
Respiratory rate higher than World Health Organization classification for age
Apnea
Increased work of breathing (eg, retractions, nasal flaring, grunting, dyspnea)d
PaO2:FiO2 ratio <250e
Multilobar infiltratesf
Pediatric early warning score >6g
Altered mental statush
Hypotensioni
Presence of effusion
Comorbid conditions (eg, sickle cell disease, immunosuppression, immunodeficiency)j
Unexplained metabolic acidosisk

Abbreviation: NIPPV, non-invasive positive pressure ventilation.

Definitions used for this study:

^aReceipt of 3 or more isotonic fluid boluses.

^bReceipt of high-flow nasal cannula, continuous positive airway pressure, bilevel positive airway pressure, or bag–valve–mask ventilation.

^cUse of aerosol or nonrebreather mask oxygen with a documented oxygen saturation of <92%.

^dPresence of retractions, dyspnea, flaring, grunting, or increased work of breathing documented by a clinician.

^eArterial blood gases are not routinely measured; therefore, SpO₂:FiO₂ was used as a proxy. An SpO₂:FiO₂ of <231 correlates with PaO₂:FiO₂ of <250 [21].

^fPresent if there were infiltrates, opacities, or consolidations noted in more than 1 lobe on chest radiograph on the official radiology report.

^gReference 19.

^hPresent if “altered mental status,” “sleeping and not arousable,” “lethargic,” or “obtunded” were documented by a clinician.

ⁱReference 20.

^jComorbid conditions were not considered in this study.

^kCO₂ of ≤15 on a chemistry panel or pH <7.35 with HCO₃ <15 or a base deficit ≤−5 on a blood gas.