New tool helps doctors know when kids with pneumonia need hospital care

Pneumonia is one of the most common infections in children. In the U.S., it’s a leading reason why kids are admitted to the hospital. But for emergency doctors, it’s not always easy to know which cases are serious — and which children will get better at home.

Now, a new study led by doctors at Children’s National Hospital and Lurie Children’s Hospital of Chicago has created a tool to help. It’s based on research from over 2,200 children treated at emergency departments in 14 countries.

The tool is simple: it uses symptoms that doctors already look for — like how fast a child is breathing, whether they’re getting enough oxygen, and if they’re drinking fluids — to score how serious their pneumonia might be. The score helps doctors decide whether a child needs to stay in the hospital, go to intensive care or can safely recover at home.

What the study found

The research team looked at children ages 3 months to 13 years who came to emergency departments with community-acquired pneumonia — a kind of pneumonia picked up outside of a hospital. Most had mild cases. But about 1 in 20 developed severe symptoms, like needing breathing support or admission to intensive care.

The team found that certain symptoms (like fast breathing or heart rate, chest retractions (a sign of struggling to breathe), low oxygen levels, refusing to drink and already being on antibiotics before coming to the hospital) were linked to a higher risk of serious illness. On the other hand, children who had a runny nose or congestion were more likely to have mild illness.

Using this data, the team created a point-based score. For example, if a child had low oxygen levels, they’d get 3 to 6 points depending on how low it was. Chest retractions added 3 points. Having a runny nose subtracted a point. The higher the total score, the greater the risk of moderate or severe pneumonia.

How it helps

The model was tested and found to be highly accurate. It performed better than doctors’ judgment alone in earlier studies — especially in spotting the children most at risk. The scorecard gives emergency doctors a fast, evidence-based way to support the decisions they make under pressure.

“Emergency departments around the world see thousands of children with pneumonia every day, but until now, we haven’t had a reliable way to predict who’s truly at risk of getting sicker,” said co-PI and senior author Nathan Kuppermann, MD, MPH, executive vice president, chief academic officer and director of the Children’s National Research Institute. “This model gives clinicians a practical tool, rooted in data, to guide that decision and ultimately improve care and outcomes.”

What’s next

While the tool is ready to be used in hospitals now, the team plans to test it in more locations and study how it affects real-world decisions. They also hope to add biomarkers — lab tests that could improve the score’s accuracy even more.

For now, the study offers something simple and powerful: a better way to know when a child’s pneumonia might become serious — and when it won’t.

The study was published in The Lancet Child & Adolescent Health and is part of a larger effort by the Pediatric Emergency Research Network (PERN), which connects emergency departments in dozens of countries.