Variability and accuracy in interpretation of consolidation on chest radiography for diagnosing pneumonia in children under 5 years of age

Williams, Gabrielle; Macaskill, Petra; Kerr, Marianne; Fitzgerald, Dominic A.; Isaacs, David; Codarini, Miriam; McCaskill, Mary; Prelog, Kristina; Craig, Jonathan C.

doi:10.1002/ppul.22806

Cited by 73 publications

(63 citation statements)

References 18 publications

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“…In other words, equipoise exists as to whether radiologic progression is clinically meaningful. The use of radiologic progression in clinical trials is limited by the fact that qualitative chest radiographic interpretations do not precisely capture degrees of change in radiologic severity [9,10]. Moreover, qualitative chest radiograph interpretations have significant inter-observer variability (i.e., low reliability) [11,12].…”

Section: Introductionmentioning

confidence: 99%

Progression of the Radiologic Severity Index predicts mortality in patients with parainfluenza virus-associated lower respiratory infections

et al. 2018

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BackgroundRadiologic severity may predict adverse outcomes after lower respiratory tract infection (LRI). However, few studies have quantified radiologic severity of LRIs. We sought to evaluate whether a semi-quantitative scoring tool, the Radiologic Severity Index (RSI), predicted mortality after parainfluenza virus (PIV)-associated LRI.MethodsWe conducted a retrospective review of consecutively-enrolled adult patients with hematologic malignancy or hematopoietic stem cell transplantation and with PIV detected in nasal wash who subsequently developed radiologically-confirmed LRI. We measured RSI (range 0–72) in each chest radiograph during the first 30 days after LRI diagnosis. We used extended Cox proportional hazards models to identify factors associated with mortality after onset of LRI with all-cause mortality as our failure event.ResultsAfter adjustment for patient characteristics, each 1-point increase in RSI was associated with an increased hazard of death (HR 1.13, 95% confidence interval [CI] 1.05–1.21, p = 0.0008). Baseline RSI was not predictive of death, but both peak RSI and the change from baseline to peak RSI (delta-RSI) predicted mortality (odds ratio for mortality, peak: 1.11 [95%CI 1.04–1.18], delta-RSI: 1.14 [95%CI 1.06–1.22]). A delta-RSI of ≥19.5 was 89% sensitive and 91% specific in predicting 30-day mortality.ConclusionsWe conclude that the RSI offers precise, informative and reliable assessments of LRI severity. Progression of RSI predicts 30-day mortality after LRI, but baseline RSI does not. Our results were derived from a cohort of patients with PIV-associated LRI, but can be applied in validated in other populations of patients with LRI.

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Section: Introductionmentioning

confidence: 99%

Progression of the Radiologic Severity Index predicts mortality in patients with parainfluenza virus-associated lower respiratory infections

et al. 2018

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“…15 120 CD + CXR 98.0 95.0 Shah et al, 21 Esposito et al 12 200 103 CXR CXR 86.0 97.9 89.0 94. 5 Reali et al 22 107 CD + CXR 94.0 96.0 Iorio et al 13 52 CD + CXR 96.5 95.6 Urbankowska et al 23 106 CXR 93.4 100.0 Ambroggio et al 18 132 CT 63.0 75.0 Samson et al 17 Zhan et al 24 200 82 CXR CXR 87.1 40.0 94.8 91.0 Sn: sensitivity; Sp: specificity; CXR: chest X-ray; CD: clinical diagnosis; CT: computed tomography.…”

Section: Resultsmentioning

confidence: 99%

Is lung ultrasonography a useful method to diagnose children with community-acquired pneumonia in emergency settings?

Çağlar

Ulusoy

et al. 2018

Hong Kong Journal of Emergency Medicine

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Background: Lung ultrasonography is a new method for diagnosing community-acquired pneumonia. Lung ultrasonography has some advantages over chest X-ray, such as lack of ionizing radiation risk, bedside performance, and cost-effectiveness. Objectives: In this study, we aimed to determine the feasibility of lung ultrasonography in emergency settings in children with community-acquired pneumonia. Methods: The study included patients younger than 18 years of age with suspicion of community-acquired pneumonia. On the first evaluation, patients with positive clinical and/or chest X-ray findings were defined to have community-acquired pneumonia, and this was accepted as the gold standard. The chest X-rays were evaluated by the chief of the pediatric emergency department, who was blinded to the patients and the lung ultrasonography results. Lung ultrasonography was performed by another pediatric emergency physician who was also blinded to the chest X-ray results and clinical findings such as fever, respiratory distress, rales, and wheezing. Results: Of the 91 patients enrolled, 71 (78.0%) were diagnosed with community-acquired pneumonia based on clinical and chest X-ray findings. The median (interquartile range) duration of the lung ultrasonography procedure was 4.0 (3.5-6.0) min. Shred sign, air bronchogram, and hepatization were significantly more frequent in the patients with communityacquired pneumonia (p < 0.01, p < 0.01, and p = 0.01, respectively). Sensitivity and specificity of lung ultrasonography were 78.5% (67.1-87.4) and 95.2% (76.1-99.8), respectively. Conclusion: Lung ultrasonography is a useful diagnostic method for children with suspicion of community-acquired pneumonia.

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“…In older child more common cause organism of pneumonia is bacterial, and among the bacteria, Streptococcus pneumoniae and H. influenzae are common and they commonly presented with lobar pneumonia. [15][16][17][18][19] But most common radiological findings in severe and very severe pneumonia was bronchopneumonia (multiple heterogeneous opacity in multiple lobes of lungs), followed by multilobar pneumonia, because diffuse involvement of lungs by multiple heterogeneous opacity or multiple lobar pneumonia, more affect the gas exchange and produce clinical severe pneumonia. 20 Patient having bronchopneumonia also required more level of care like O2 inhalation, ICU care and ventilatory support in comparison to other pneumonia and duration of hospitalization is also more in these patients.…”

Section: Discussionmentioning

confidence: 99%

Can chest x-ray predict pneumonia severity and its outcome in children aged 2 months - 5 years?

Goyal

Sareen

2020

Int J Contemp Pediatr

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Background: Worldwide 16% of death in children under the age 5 years is only due to pneumonia every year. Among the diagnostic modality x-ray chest is simple tool to diagnose the pneumonia especially in developing country like in India. Aims of study was to know the incidence of radiologically proven pneumonia and to see the correlation between x-rays findings and clinical severity of pneumonia, so as to predict the severity of pneumonia on the basis of x-ray chest done on first day of hospitalization.Methods: We did the study in department of pediatrics at tertiary care centre, total 150 patients of pneumonia (2 months to 5 years age) enrolled on clinical basis. X-ray chest done in all patients on first contact.Results: Out of 150 patients, 54% of patient having radiologically proven pneumonia while 46% were normal x-ray findings. We found that interstitial pneumonia were more common in younger children, but lobar pneumonia were more common in older children, but in severe and very severe pneumonia cases most common radiologically proven pneumonia were bronchopneumonia in all age group, which was statistically significant.Conclusions: So the basis of start of treatment should be on the clinical background and clinical severity, not only on the basis of x-ray chest findings. Late x-ray films give more chance of positive findings, multilobar infiltration or diffuse heterogeneous opacity in lungs positively correlated with clinical severity and gives idea about course and duration of hospitalization.

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Variability and accuracy in interpretation of consolidation on chest radiography for diagnosing pneumonia in children under 5 years of age

Cited by 73 publications

References 18 publications

Progression of the Radiologic Severity Index predicts mortality in patients with parainfluenza virus-associated lower respiratory infections

Progression of the Radiologic Severity Index predicts mortality in patients with parainfluenza virus-associated lower respiratory infections

Is lung ultrasonography a useful method to diagnose children with community-acquired pneumonia in emergency settings?

Can chest x-ray predict pneumonia severity and its outcome in children aged 2 months - 5 years?

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