LAUSR

Background The ‘pneumococcal urinary antigen protein’ assay is a commonly used, and widely accepted, aide in diagnosing pneumonia amongst adult patients. There is little evidence for its use in the paediatric population and it is not validated for use in patients 6 years of age and younger. Nevertheless, there has been an emerging trend in its use at our hospital in the paediatric setting. Interestingly, there seems to have been significant positive correlation between a positive result and clinical presentations consistent with Community Acquired Pneumonia (CAP). Aim Our aim is to review the frequency of pneumococcal urinary antigen testing in the paediatric population over the last two years at UHL. We are assessing the relationship between a positive result and other markers of inflammation (WBC, Neutrophilia, Elevated CRP, Elevated Platelet count, Decreased serum albumin), the presence of consolidation on Chest X-Ray, vital signs at presentation in ED, first line antibiotic therapy prescribed, need for second line antibiotics and the presence of associated complications. Specifically, we endeavour to determine if a positive result in children and adolescent patients relates to a clinical outcome consistent with CAP. Methods To search for all patients 16 years of age and under who had a positive result using the iLab software. iLab will also be used to assess other markers of inflammation, in the same patient cohort, at time of admission. Corresponding chest radiograph images and reports will be accessed via the NIMIS radiology software. Vital signs at time of presentation will be assessed using the ‘Therefore’ software. Information regarding antibiotic treatment and any complications can be accessed using the hospital’s E-discharge summary system Results There were X paediatric patients who had their pneumococcal urinary antigen protein tested in UHL from January 2017 to December 2018 inclusive, X of which tested positive. Of the positively resulted cohort, X had evidence of consolidation on CXR, X had corresponding markers of inflammation at ED. X% of patients required antibiotic therapy and a further X% required second line antibiotic therapy. X patients had clinical features of acute infection at presentation and X amount of patients had associated complications. Conclusion The results of this review indicate a correlation between a positive result and clinical presentation of CAP. This may well support the use of the pneumococcal urinary antigen protein assay as part of the work up for paediatric patients presenting with symptoms concerning for CAP.