ACR Appropriateness Criteria® Pneumonia in the Immunocompetent Child

Chan, Sherwin S; Kotecha, Manish K; Rigsby, Cynthia K.; Iyer, Ramesh S.; Alazraki, Adina; Anupindi, Sudha A.; Bardo, Dianna M. E.; Brown, Brandon P.; Chandra, Tushar; Dorfman, Scott R.; Garber, Matthew; Moore, Michael J.; Nguyen, Jie C.; Shet, Narendra; Siegel, Alan; Valente, Jonathan H.; Karmazyn, Boaz

doi:10.1016/j.jacr.2020.01.033

Cited by 10 publications

(5 citation statements)

References 57 publications

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“…According to the American College of Radiology Appropriateness Criteria, imaging is not indicated in a well-appearing immunocompetent child older than 3 months of age who does not require hospitalization. However, if the child is not responding to outpatient management or requires hospitalization, chest radiography is considered the most appropriate first step in imaging evaluation (114). Similar to the adult population, the Radiological Society of North America consensus statement on pediatric patients with respect to use of CT states that chest CT should be reserved for symptomatic hospitalized patients with specific clinical indications (115).…”

Section: Pediatric Manifestationsmentioning

confidence: 99%

Multisystem Imaging Manifestations of COVID-19, Part 2: From Cardiac Complications to Pediatric Manifestations

et al. 2020

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Infection with severe acute respiratory syndrome coronavirus 2 results in coronavirus disease 2019 (COVID-19), which was declared an official pandemic by the World Health Organization on March 11, 2020. COVID-19 has been reported in most countries, and as of August 15, 2020, there have been over 21 million cases of COVID-19 reported worldwide, with over 800 000 COVID-19-associated deaths. Although COVID-19 predominantly affects the respiratory system, it has become apparent that many other organ systems can also be involved. Imaging plays an essential role in the diagnosis of all manifestations of the disease and its related complications, and proper utilization and interpretation of imaging examinations is crucial. A comprehensive understanding of the diagnostic imaging hallmarks, imaging features, multisystem involvement, and evolution of imaging findings is essential for effective patient management and treatment. In part 1 of this article, the authors described the viral pathogenesis, diagnostic imaging hallmarks, and manifestations of the pulmonary and peripheral and central vascular systems of COVID-19. In part 2 of this article, the authors focus on the key imaging features of the varied pathologic manifestations of COVID-19, involving the cardiac, neurologic, abdominal, dermatologic and ocular, and musculoskeletal systems, as well as the pediatric and pregnancy-related manifestations of the virus.

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Section: Pediatric Manifestationsmentioning

confidence: 99%

Multisystem Imaging Manifestations of COVID-19, Part 2: From Cardiac Complications to Pediatric Manifestations

et al. 2020

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“…Hence, children are far more susceptible to the carcinogenic effects of ionizing radiation than adults, and children have a longer life expectancy, creating a greater window of opportunity for radiation harm to manifest [ 13 ]. According to the American College of Radiology Appropriateness Criteria, imaging is not required in well-appearing immunocompetent children ≥ 3 months of age who do not require hospitalization [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

Serum LDH: a potential surrogate to chest radiograph in pediatric Covid-19 patients to reduce radiation exposure

Das

Alkoteesh

AlBastaki

et al. 2022

Egypt J Radiol Nucl Med

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Background Chest radiographs are frequently used to evaluate pediatric patients with COVID-19 infection during the current pandemic. Despite the minimal radiation dose associated with chest radiography, children are far more sensitive to ionizing radiation's carcinogenic effects than adults. This study aimed to examine whether serum biochemical markers could be potentially used as a surrogate for imaging findings to reduce radiation exposure. Methods The retrospective posthoc analysis of 187 pediatric patients who underwent initial chest radiographs and serum biochemical parameters on the first day of emergency department admission. The cohort was separated into two groups according to whether or not the initial chest radiograph revealed evidence of pneumonia. Spearman's rank correlation was used to connect serum biochemical markers with observations on chest radiographs. The Student's t-test was employed for normally distributed data, and for non-normally distributed data, the Mann–Whitney U test was used. A simple binary logistic regression was used to determine the importance of LDH in predicting chest radiographs. The discriminating ability of LDH in predicting chest radiographs was determined using receiver operating characteristics (ROC) analysis. The cut-off value was determined using Youden's test. Interobserver agreement was quantified using the Cohen k coefficient. Results 187 chest radiographs from 187 individual pediatric patients (95 boys and 92 girls; mean age ± SD, 10.1 ± 6.0 years; range, nine months–18 years) were evaluated. The first group has 103 patients who did not have pneumonia on chest radiographs, while the second group contains 84 patients who had evidence of pneumonia on chest radiographs. GGO, GGO with consolidation, consolidation, and peri-bronchial thickening were deemed radiographic evidence of pneumonia in group 2 patients. Individuals in group 2 with radiological indications of pneumonia had significantly higher LDH levels (p = 0.001) than patients in group 1. The Spearman's rank correlation coefficient between LDH and chest radiography score is 0.425, showing a significant link. With a p-value of < 0.001, the simple binary logistic regression analysis result validated the relevance of LDH in predicting chest radiography. An abnormal chest radiograph was related to LDH > 200.50 U/L (AUC = 0.75), according to the ROC method. Interobserver agreement between the two reviewers was almost perfect for chest radiography results in both groups (k = 0.96, p = 0.001). Conclusion This study results show that, compared to other biochemical indicators, LDH has an 80.6% sensitivity and a 62% specificity for predicting abnormal chest radiographs in a pediatric patient with confirmed COVID-19 infection. It also emphasizes that biochemical measures, rather than chest radiological imaging, can detect the pathogenic response to COVID-19 infection in the chest earlier. As a result, we hypothesized LDH levels might be potentially used instead of chest radiography in children with COVID-19, reducing radiation exposure.

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“…In cases where pleural involvement has to be assessed, the timing of the acquisition after intravenous contrast injection should be longer for the better enhancement of pleural folds. Lastly, CT is the technique of choice in children with recurrent pneumonia to determine the cause of recurrent infections, such as aspirated foreign bodies or possible congenital lung abnormalities [10,[27][28][29].…”

Section: Computed Tomographymentioning

confidence: 99%

Imaging of Acute Complications of Community-Acquired Pneumonia in the Paediatric Population—From Chest Radiography to MRI

Alexopoulou,

Prountzos,

Raissaki

et al. 2024

Children

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The most common acute infection and leading cause of death in children worldwide is pneumonia. Clinical and laboratory tests essentially diagnose community-acquired pneumonia (CAP). CAP can be caused by bacteria, viruses, or atypical microorganisms. Imaging is usually reserved for children who do not respond to treatment, need hospitalisation, or have hospital-acquired pneumonia. This review discusses the imaging findings for acute CAP complications and the diagnostic role of each imaging modality. Pleural effusion, empyema, necrotizing pneumonia, abscess, pneumatocele, pleural fistulas, and paediatric acute respiratory distress syndrome (PARDS) are acute CAP complications. When evaluating complicated CAP patients, chest radiography, lung ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI) can be used, with each having their own pros and cons. Imaging is usually not needed for CAP diagnosis, but it is essential for complicated cases and follow-ups. Lung ultrasound can supplement chest radiography (CR), which starts the diagnostic algorithm. Contrast-enhanced computed tomography (CECT) is used for complex cases. Advances in MRI protocols make it a viable alternative for diagnosing CAP and its complications.

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ACR Appropriateness Criteria® Pneumonia in the Immunocompetent Child

Cited by 10 publications

References 57 publications

Multisystem Imaging Manifestations of COVID-19, Part 2: From Cardiac Complications to Pediatric Manifestations

Multisystem Imaging Manifestations of COVID-19, Part 2: From Cardiac Complications to Pediatric Manifestations

Serum LDH: a potential surrogate to chest radiograph in pediatric Covid-19 patients to reduce radiation exposure

Imaging of Acute Complications of Community-Acquired Pneumonia in the Paediatric Population—From Chest Radiography to MRI

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