International Journal of Clinical Case Reports 2024, Vol.14, No.3, 157-166 http://medscipublisher.com/index.php/ijccr 161 4.4 Mortality rates Mortality rates are a crucial outcome measure in evaluating the effectiveness of treatments for ALRIs. The mortality rate among children with severe ALRIs and SARS-CoV-2 infection was higher compared to those without the infection, with 8.1% of SARS-CoV-2 positive cases resulting in death compared to 2.0% of non-SARS-CoV-2 cases11. In contrast, a study on children with BPD and RSV-ALRI reported a higher in-hospital case fatality rate (hCFR) for BPD children compared to non-BPD children, with an odds ratio of 12.8 (Chaw et al., 2019b). These findings underscore the importance of identifying and managing high-risk groups to reduce mortality rates in children with ALRIs. 5 Comparative Analysis of Treatment Approaches 5.1 Comparison of treatment efficacy The efficacy of various treatment approaches for acute lower respiratory infections (ALRI) in children has been extensively studied. Non-invasive ventilation (NIV) strategies, such as continuous positive airway pressure (CPAP) and high flow nasal cannula (HFNC), have shown promising results. A systematic review and Bayesian network meta-analysis revealed that CPAP significantly reduced the risk of intubation compared to standard oxygen therapy (OR: 0.40, 95% CrI: 0.16–0.90) and both CPAP and HFNC were associated with a lower risk of treatment failure (OR: 0.42, 95% CrI: 0.19–0.81 for CPAP and OR: 0.51, 95% CrI: 0.29–0.81 for HFNC) (Wang et al., 2021). However, no significant differences were observed among the interventions for in-hospital mortality. In contrast, the use of antibiotics for uncomplicated lower respiratory tract infections (LRTIs) in children has been questioned. A double-blind, randomized, placebo-controlled trial found that amoxicillin did not significantly reduce the duration of symptoms rated moderately bad or worse compared to placebo (HR 1.13, 95% CI 0.90-1.42) (Little et al., 2021). This suggests that antibiotics may not be clinically effective for uncomplicated chest infections in children. 5.2 Factors influencing treatment outcomes Several factors have been identified that influence the outcomes of ALRI treatments in children. A systematic review and meta-analysis identified key risk factors for poor outcomes and mortality in children with respiratory syncytial virus-associated ALRI (RSV-ALRI). These factors include any comorbidity (OR 2.69, 95% CI 1.89-3.83), congenital heart disease (OR 3.40, 95% CI 2.14-5.40), prematurity with gestational age (GA) <37 weeks (OR 1.75, 95% CI 1.31-2.36), and age <6 months (OR 2.02, 95% CI 1.73-2.35) (Shi et al., 2021). These findings highlight the importance of considering underlying health conditions and age when evaluating treatment strategies. Additionally, children with bronchopulmonary dysplasia (BPD) are at a higher risk of severe RSV disease, with increased rates of hospitalization, ICU admission, and mechanical ventilation compared to those without BPD (Chaw , 2019b). This underscores the need for tailored treatment approaches for high-risk groups. 5.3 Cost-effectiveness of treatments The cost-effectiveness of different treatment strategies for ALRI in children has also been evaluated. A study on the implementation of a decision rule-based treatment strategy in children with suspected lower respiratory tract infections in the emergency department (ED) found that this approach was cost-saving. The mean costs per patient were reduced from €2300 during usual care to €1870 during the intervention phase, primarily due to reduced hospitalization and parental absenteeism (Maat et al., 2020). This suggests that decision rule-based strategies can be economically beneficial while maintaining clinical effectiveness. Moreover, a randomized trial comparing delayed antibiotic prescription (DAP) to immediate antibiotic prescription (IAP) and no antibiotic prescription (NAP) found that DAP significantly reduced antibiotic use and gastrointestinal adverse effects without compromising symptom duration or severity (Mas-Dalmau et al., 2021). This indicates that DAP can be a cost-effective strategy by minimizing unnecessary antibiotic use and associated side effects.
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