There exists a wide array of conflicting evidence in terms of how we assess pneumonia severity in children. I wanted to direct your attention to a recently published systematic review from Preston Dean and Todd Florin. Given that definitions of mild, moderate and severe pneumonia vary, their aim was to describe the current state of the evidence for defining and predicting pneumonia severity in children and elaborate upon emerging evidence focused on risk stratification of children with pneumonia. In order to accomplish this they conducted a systematic review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. Please read the paper for yourself, as it goes into depth on not only individual symptoms and findings, but also current guidelines.
In summary, Dean and Florin noted that the current evidence suggests that the following factors are most predictive of pneumonia severity in children:
- Altered mental status
- Age <3–6 months
- Multilobar infiltrates
- Moderate/large pleural effusions