Early risk stratification for ICU admission in hospitalized children with pertussis: development and internal validation of an admission-time prediction model.

backgroundSevere pertussis in children can deteriorate rapidly, and early identification of patients likely to require intensive care remains challenging. We aimed to develop and internally validate an admission-time prediction model for ICU admission among hospitalized children with PCR-confirmed pertussis.

methodsWe conducted a single-center retrospective prediction-model study based on a hospitalized cohort at a provincial pediatric infectious disease center. Consecutive hospitalized children with PCR-confirmed pertussis between 6 June 2020 and 24 June 2025 were screened. Two children were excluded because admission white blood cell count (WBC), a prespecified core predictor, was unavailable in the retrievable admission-time record, leaving 662 children aged 24 days to 14 years for analysis. The primary outcome was ICU admission, defined a priori as ICU length of stay > 0 days. We prespecified a multivariable logistic regression model using seven admission-time predictors: age (months), sex, symptom duration before admission (days), paroxysmal cyanosis documented at presentation, imaging consolidation/atelectasis, admission WBC scaled per 5 × 10

resultsICU admission occurred in 61/662 (9.2%) children. Compared with non-ICU patients, ICU-admitted children were younger (median 2.0 vs 60.0 months) and had higher admission WBC (median 18.7 vs 10.0 × 10

conclusionsAn admission-time multivariable model showed good internal performance for predicting ICU admission in pediatric pertussis and may support early risk stratification. External validation is required before routine implementation.