Introduction. Differentiating bacterial from viral pneumonia is critical, particularly in severe cases progressing to respiratory failure, to guide timely and appropriate antibiotic therapy. The Bacterial Pneumonia Score (BPS) aims to facilitate rapid identification of bacterial pneumonia and distinguishing the causative pathogens of severe pneumonia with respiratory failure in children.
The objective of the study was to determine the diagnostic value and optimal cut-off point of BPS in identifying severe bacterial pneumonia complicated by respiratory failure in children.
Material and methods. A cross-sectional study was conducted on 76 children aged 2 months to 5 years, having severe pneumonia with respiratory failure within 48 hours of hospital admission, from May 2023 to January 2024. Bacterial pneumonia was confirmed using real-time PCR from tracheal aspirates. Epidemiological, clinical, and laboratory data were collected, and BPS was calculated for analysis.
Results. Among 76 cases, 63 (82.9%) had severe bacterial pneumonia, predominantly in children with a history of recurrent pneumonia, incomplete vaccination, and illness duration >3 days. Higher absolute neutrophil counts (p<0.001) and increased neutrophil-to-lymphocyte ratio (p=0.0001) were observed in bacterial cases. BPS ≥4 had 46.1% sensitivity, 92.3% specificity, positive likelihood ratio (LR+) of 5.9, and negative likelihood ratio (LR-) of 0.6. BPS demonstrated a moderate predictive value, AUC of 0.7265 (95% CI: 0.59–0.86, p=0.0055). The optimal cut-off, BPS ≥3, yielded a sensitivity of 52.4%, a specificity of 92.3%, LR+ of 6.8 and LR- of 0.5.
Conclusions. BPS may serve as a predictive tool for severe bacterial pneumonia; however, a BPS ≥4 has a relatively low sensitivity. A lower BPS threshold should be considered in identifying severe bacterial pneumonia with respiratory failure.
Keywords: severe pneumonia, respiratory failure, Bacterial Pneumonia Score, cut-off.
Email to Author
Address for correspondence:
Chi Quang NGO
Department of Pediatrics, Faculty of Medicine, Can Tho University of
Medicine and Pharmacy, Can Tho City 90000, Vietnam
E-mail: ncquang@ctump.edu.vn
