{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T23:49:59Z","timestamp":1788306599510,"version":"build-2803163510"},"reference-count":11,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"7","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Pediatr Emer Care"],"published-print":{"date-parts":[[2023,7]]},"abstract":"<jats:sec>\n            <jats:title>Objective<\/jats:title>\n            <jats:p>To evaluate the role of virus detection on disease severity among children presenting to the emergency department (ED) with suspected community-acquired pneumonia (CAP).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>We performed a single-center prospective study of children presenting to a pediatric ED with signs and symptoms of a lower respiratory tract infection and who had a chest radiograph performed for suspected CAP. We included patients who had virus testing, with results classified as negative for virus, human rhinovirus, respiratory syncytial virus (RSV), influenza, and other viruses. We evaluated the association between virus detection and disease severity using a 4-tiered measure of disease severity based on clinical outcomes, ranging from <jats:italic toggle=\"yes\">mild (<\/jats:italic>discharged from the ED) to <jats:italic toggle=\"yes\">severe<\/jats:italic> (receipt of positive-pressure ventilation, vasopressors, thoracostomy tube placement, or extracorporeal membrane oxygenation, intensive care unit admission, diagnosis of severe sepsis or septic shock, or death) in models adjusted for age, procalcitonin, C-reactive protein, radiologist interpretation of the chest radiograph, presence of wheeze, fever, and provision of antibiotics.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Five hundred seventy-three patients were enrolled in the parent study, of whom viruses were detected in 344 (60%), including 159 (28%) human rhinovirus, 114 (20%) RSV, and 34 (6%) with influenza. In multivariable models, viral infections were associated with increasing disease severity, with the greatest effect noted with RSV (adjusted odds ratio [aOR], 2.50; 95% confidence interval [CI], 1.30\u20134.81) followed by rhinovirus (aOR, 2.18; 95% CI, 1.27\u20133.76). Viral detection was not associated with increased severity among patients with radiographic pneumonia (n = 223; OR, 1.82; 95% CI, 0.87\u20133.87) but was associated with severity among patients without radiographic pneumonia (n = 141; OR, 2.51; 95% CI, 1.40\u20134.59).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>The detection of a virus in the nasopharynx was associated with more severe disease compared with no virus; this finding persisted after adjustment for age, biomarkers, and radiographic findings. Viral testing may assist with risk stratification of patients with lower respiratory tract infections.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/pec.0000000000002982","type":"journal-article","created":{"date-parts":[[2023,6,13]],"date-time":"2023-06-13T00:00:09Z","timestamp":1686614409000},"page":"465-469","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":5,"title":["Viral Detection Is Associated With Severe Disease in Children With Suspected Community-Acquired Pneumonia"],"prefix":"10.1097","volume":"39","author":[{"given":"Sriram","family":"Ramgopal","sequence":"first","affiliation":[{"name":"Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jillian M.","family":"Cotter","sequence":"additional","affiliation":[{"name":"Section of Pediatric Hospital Medicine, Children's Hospital Colorado, Department of Pediatrics, University of Colorado, Aurora, CO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nidhya","family":"Navanandan","sequence":"additional","affiliation":[{"name":"Section of Emergency Medicine, Children's Hospital Colorado, Department of Pediatrics, University of Colorado, Aurora, CO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samir S.","family":"Shah","sequence":"additional","affiliation":[{"name":"Divisions of Hospital Medicine and Infectious Diseases, Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine, Cincinnati, OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard M.","family":"Ruddy","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lilliam","family":"Ambroggio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Todd A.","family":"Florin","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"bib1-20250504","first-page":"316","article-title":"Common diagnoses and costs in pediatric hospitalization in the US","volume":"176","year":"2021","journal-title":"JAMA Pediatr"},{"key":"bib2-20250504","doi-asserted-by":"crossref","first-page":"1346","DOI":"10.1086\/521626","article-title":"Incidence of pneumococcal disease due to non-pneumococcal conjugate vaccine (PCV7) serotypes in the United States during the era of widespread PCV7 vaccination, 1998\u20132004","volume":"196","year":"2007","journal-title":"J Infect Dis"},{"key":"bib3-20250504","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1056\/NEJMoa1405870","article-title":"Community-acquired pneumonia requiring hospitalization among U.S. children","volume":"372","year":"2015","journal-title":"N Engl J Med"},{"key":"bib4-20250504","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1016\/j.jcv.2010.05.007","article-title":"Correlation of viral load of respiratory pathogens and co-infections with disease severity in children hospitalized for lower respiratory tract infection","volume":"48","year":"2010","journal-title":"J Clin Virol"},{"key":"bib5-20250504","doi-asserted-by":"crossref","first-page":"e20161019","DOI":"10.1542\/peds.2016-1019","article-title":"Predicting severe pneumonia outcomes in children","volume":"138","year":"2016","journal-title":"Pediatrics"},{"key":"bib6-20250504","doi-asserted-by":"crossref","first-page":"e2713","DOI":"10.1093\/cid\/ciaa1690","article-title":"Development and internal validation of a prediction model to risk stratify children with suspected community-acquired pneumonia","volume":"73","year":"2021","journal-title":"Clin Infect Dis"},{"key":"bib9-20250504","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1186\/s13052-021-01042-3","article-title":"Age-specific risk factors of severe pneumonia among pediatric patients hospitalized with community-acquired pneumonia","volume":"47","year":"2021","journal-title":"Ital J Pediatr"},{"key":"bib10-20250504","doi-asserted-by":"crossref","first-page":"1831","DOI":"10.1002\/jmv.21590","article-title":"Rhinovirus infections in children: a retrospective and prospective hospital-based study","volume":"81","year":"2009","journal-title":"J Med Virol"},{"key":"bib11-20250504","doi-asserted-by":"crossref","first-page":"490","DOI":"10.1097\/INF.0000000000000622","article-title":"Association between bacterial infection and radiologically confirmed pneumonia among children","volume":"34","year":"2015","journal-title":"Pediatr Infect Dis J"},{"key":"bib12-20250504","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1097\/INF.0b013e3181cdafc2","article-title":"Viral coinfections in children with invasive pneumococcal disease","volume":"29","year":"2010","journal-title":"Pediatr Infect Dis J"},{"key":"bib13-20250504","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1093\/jpids\/piw091","article-title":"Procalcitonin accurately identifies hospitalized children with low risk of bacterial community-acquired pneumonia","volume":"7","year":"2018","journal-title":"J Pediatric Infect Dis Soc"}],"container-title":["Pediatric Emergency Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/10.1097\/PEC.0000000000002982","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,4]],"date-time":"2025-05-04T18:09:17Z","timestamp":1746382157000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.1097\/PEC.0000000000002982"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7]]},"references-count":11,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2023]]}},"URL":"https:\/\/doi.org\/10.1097\/pec.0000000000002982","relation":{},"ISSN":["1535-1815","0749-5161"],"issn-type":[{"value":"1535-1815","type":"electronic"},{"value":"0749-5161","type":"print"}],"subject":[],"published":{"date-parts":[[2023,7]]}}}