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Multicenter Study
. 2017 Jun 15;64(suppl_3):S262-S270.
doi: 10.1093/cid/cix089.

Chest Radiograph Findings in Childhood Pneumonia Cases From the Multisite PERCH Study

Nicholas Fancourt  1   2   3 , Maria Deloria Knoll  1 , Henry C Baggett  4   5 , W Abdullah Brooks  6   7 , Daniel R Feikin  1   8 , Laura L Hammitt  1   9 , Stephen R C Howie  10   11   12 , Karen L Kotloff  13 , Orin S Levine  1   14 , Shabir A Madhi  15   16 , David R Murdoch  17   18 , J Anthony G Scott  9   19 , Donald M Thea  20 , Juliet O Awori  9 , Breanna Barger-Kamate  21   22 , James Chipeta  23   24 , Andrea N DeLuca  1   25 , Mahamadou Diallo  26 , Amanda J Driscoll  1 , Bernard E Ebruke  10 , Melissa M Higdon  1 , Yasmin Jahan  7 , Ruth A Karron  27 , Nasreen Mahomed  15   28 , David P Moore  15   16   29 , Kamrun Nahar  7 , Sathapana Naorat  4 , Micah Silaba Ominde  9 , Daniel E Park  1   30 , Christine Prosperi  1 , Somwe Wa Somwe  23 , Somsak Thamthitiwat  4 , Syed M A Zaman  10   31 , Scott L Zeger  32 , Katherine L O'Brien  1 ; PERCH Study Group
Collaborators, Affiliations
Multicenter Study

Chest Radiograph Findings in Childhood Pneumonia Cases From the Multisite PERCH Study

Nicholas Fancourt et al. Clin Infect Dis. .

Abstract

Background.: Chest radiographs (CXRs) are frequently used to assess pneumonia cases. Variations in CXR appearances between epidemiological settings and their correlation with clinical signs are not well documented.

Methods.: The Pneumonia Etiology Research for Child Health project enrolled 4232 cases of hospitalized World Health Organization (WHO)-defined severe and very severe pneumonia from 9 sites in 7 countries (Bangladesh, the Gambia, Kenya, Mali, South Africa, Thailand, and Zambia). At admission, each case underwent a standardized assessment of clinical signs and pneumonia risk factors by trained health personnel, and a CXR was taken that was interpreted using the standardized WHO methodology. CXRs were categorized as abnormal (consolidation and/or other infiltrate), normal, or uninterpretable.

Results.: CXRs were interpretable in 3587 (85%) cases, of which 1935 (54%) were abnormal (site range, 35%-64%). Cases with abnormal CXRs were more likely than those with normal CXRs to have hypoxemia (45% vs 26%), crackles (69% vs 62%), tachypnea (85% vs 80%), or fever (20% vs 16%) and less likely to have wheeze (30% vs 38%; all P < .05). CXR consolidation was associated with a higher case fatality ratio at 30-day follow-up (13.5%) compared to other infiltrate (4.7%) or normal (4.9%) CXRs.

Conclusions.: Clinically diagnosed pneumonia cases with abnormal CXRs were more likely to have signs typically associated with pneumonia. However, CXR-normal cases were common, and clinical signs considered indicative of pneumonia were present in substantial proportions of these cases. CXR-consolidation cases represent a group with an increased likelihood of death at 30 days post-discharge.

Keywords: .; chest radiograph; mortality; pediatrics; pneumonia; signs and symptoms.

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Figures

Figure 1.
Figure 1.
Flow diagram of case enrollment, chest radiograph (CXR) conclusions, and CXR status stratified by 30-day follow-up findings.
Figure 2.
Figure 2.
Distribution of chest radiograph conclusions by site, for interpretable images only (n = 3587). Abbreviation: B, Bangladesh; Both, both consolidation and other infiltrate.
See this image and copyright information in PMC

Comment in

References

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