Introducing a New Algorithm for Classification of Etiology in Studies on Pediatric Pneumonia: Protocol for the Trial of Respiratory Infections in Children for Enhanced Diagnostics Study

Samuel Arthur Rhedin; Annika Eklundh; Malin Ryd-Rinder; Pontus Naucler; Andreas Mårtensson; Jesper Gantelius; Ingela Zenk; Helene Andersson-Svahn; Susanna Nybond; Reza Rasti; Magnus Lindh; Maria Andersson; Ville Peltola; Matti Waris; Tobias Alfvén

doi:10.2196/12705

Introducing a New Algorithm for Classification of Etiology in Studies on Pediatric Pneumonia: Protocol for the Trial of Respiratory Infections in Children for Enhanced Diagnostics Study

JMIR Res Protoc. 2019 Apr 26;8(4):e12705. doi: 10.2196/12705.

Authors

Samuel Arthur Rhedin^{1

2}, Annika Eklundh¹, Malin Ryd-Rinder³, Pontus Naucler⁴, Andreas Mårtensson⁵, Jesper Gantelius⁶, Ingela Zenk¹, Helene Andersson-Svahn⁶, Susanna Nybond⁶, Reza Rasti^{1

7}, Magnus Lindh⁸, Maria Andersson⁸, Ville Peltola⁹, Matti Waris⁹, Tobias Alfvén^{1

7}

Affiliations

¹ Sachs' Children and Youth Hospital, South General Hospital, Stockholm, Sweden.
² Department of Medical Epidemiology and Biostatistics, Karolinska Insitutet, Stockholm, Sweden.
³ Astrid Lindgren Children's Hospital, Stockholm, Sweden.
⁴ Division of Infectious Diseases, Department of Medicine, Solna, Karolinska Institutet & Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.
⁵ Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University, Uppsala, Sweden.
⁶ Science for Life Laboratory, Division of Proteomics and Nanobiotechnology, KTH Royal Institute of Technology, Stockholm, Sweden.
⁷ Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
⁸ Department of Infectious Diseases, University of Gothenburg, Gothenburg, Sweden.
⁹ Department of Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland.

PMID: 31025954
PMCID: PMC6658235
DOI: 10.2196/12705

Abstract

Background: There is a need to better distinguish viral infections from antibiotic-requiring bacterial infections in children presenting with clinical community-acquired pneumonia (CAP) to assist health care workers in decision making and to improve the rational use of antibiotics.

Objective: The overall aim of the Trial of Respiratory infections in children for ENhanced Diagnostics (TREND) study is to improve the differential diagnosis of bacterial and viral etiologies in children aged below 5 years with clinical CAP, by evaluating myxovirus resistance protein A (MxA) as a biomarker for viral CAP and by evaluating an existing (multianalyte point-of-care antigen detection test system [mariPOC respi] ArcDia International Oy Ltd.) and a potential future point-of-care test for respiratory pathogens.

Methods: Children aged 1 to 59 months with clinical CAP as well as healthy, hospital-based, asymptomatic controls will be included at a pediatric emergency hospital in Stockholm, Sweden. Blood (analyzed for MxA and C-reactive protein) and nasopharyngeal samples (analyzed with real-time polymerase chain reaction as the gold standard and antigen-based mariPOC respi test as well as saved for future analyses of a novel recombinase polymerase amplification-based point-of-care test for respiratory pathogens) will be collected. A newly developed algorithm for the classification of CAP etiology will be used as the reference standard.

Results: A pilot study was performed from June to August 2017. The enrollment of study subjects started in November 2017. Results are expected by the end of 2019.

Conclusions: The findings from the TREND study can be an important step to improve the management of children with clinical CAP.

International registered report identifier (irrid): DERR1-10.2196/12705.

Keywords: child, preschool; diagnostic tests, routine; microbiological techniques; pneumonia; respiratory tract infections.

©Samuel Arthur Rhedin, Annika Eklundh, Malin Ryd-Rinder, Pontus Naucler, Andreas Mårtensson, Jesper Gantelius, Ingela Zenk, Helene Andersson-Svahn, Susanna Nybond, Reza Rasti, Magnus Lindh, Maria Andersson, Ville Peltola, Matti Waris, Tobias Alfvén. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 26.04.2019.