Clinical predictors of radiological pneumonia in children with severe community acquired pneumonia
Keywords:Pneumonia, Paediatrics, WHO
Background: Pneumonia causes one-third of all under 5 deaths from infections. Typically cough, fever, pleuritic chest pain, fatigue and loss of appetite are presenting symptoms of pneumonia. Even though chest radiograph improves the diagnosis of paediatric community acquired pneumonia to a certain degree, however its interpretation is subjective, moreover exposure to ionizing radiation, cost, the time and space used, and the need to wait for the radiograph and to see the clinician again limits its use in in resource limited settings. In this study, it was aimed to determine clinical predictors of radiological pneumonia in children with severe community acquired pneumonia which may help in judicious use of X-ray and rational management with antibiotics, in these children.
Methods: This was a case control, observational study which was conducted in post graduate department of paediatrics, children hospital on all paediatric patients between ages 2 months and 5 years, who presented to the paediatric emergency department and were diagnosed with severe community acquired pneumonia as per World Health Organization (WHO) guidelines, were included.
Results: The study was conducted on 100 cases of severe radiological pneumonia and 200 controls of non-radiological pneumonia. From admission to discharge, children were followed and multiple clinical parameters were compared. Among 100 cases, 72 (72%) had wheezing, 70 (70%) had cyanosis, 67 (67%) had tachypnea, 67 (67%) had hypoxemia, 59 (59%) had grunting, and 42 (42%) had bronchial breathing. Similarly, among 200 controls, 165 (82.5%) had wheezing, 116 (58%) had cyanosis, 97 (48.5%) had tachypnea, 58 (29%) had hypoxemia, 90 (45%) had grunting and 19 (9.5%) had bronchial breathing. The difference is statistically significant.
Conclusions: It can be concluded from our study that presence of cyanosis, tachypnea, hypoxemia, grunting and bronchial breathing are the positive predictors of radiological pneumonia, while as presence of wheezing are negative predictors of radiological pneumonia.
Grief SN, Loza JK. Guidelines for the evaluation and treatment of pneumonia. Prim Care. 2018;45(3):485-503.
Maheshwari M, Maheshwari S. “Clinico-radiological profile and outcome of novel H1N1-infected patients during 2009 to 2014 pandemic at tertiary referral hospital in Rajasthan. J Assoc Physicians India. 2015;63:42-5.
O'Grady KF, Torzillo PJ, Frawley K, Chang AB. The radiological diagnosis of pneumonia in children. Pneumonia (Nathan). 2014;5(1):38-51.
Magree HC, Russell FM, Sa’aga R. Chest X-ray confirmed pneumonia in children in Fiji. Bull World Health Organ. 2005;83(6):427-33.
World Health Organization. Integrated Management of Childhood Illnesses, WHO, Geneva, Switzerland. 2014. Available at: http://www.who.int/maternal child adolescent/documents/IMCI_chartbooklet/en/. Accessed on 23 April 2023.
Cherian T, Mulholland EK, Carlin JB. Standardized interpretation of paediatric chest radiographs for the diagnosis of pneumonia in epidemiological studies. Bull World Health Organ. 2005;83(5):353-9.
Begom A, Choudhury AM, Islam MN, Ali MA, Hossain MA, Hoque MA, et al. Clinical and Radiological Evaluation of Children Aged 2 Months to 5 Years with Severe Pneumonia According to WHO Guideline. Mymensingh Med J. 2018;27(4):702-9.
Dai Y. Respiratory rate and signs in roentgenographically confirmed pneumonia among children in China. Paediatric Infect Dis J. 1995;14(1):48-50.
Palafox M, Guiscafré H, Reyes H, Muñoz O, Martínez H. Diagnostic value of tachypnoea in pneumonia defined radiologically. Arch Dis Child. 2000;82(1):41-5.
Karim R, Afridi JK, Khizar S, Khizar A, Hussain A. To determine the diagnostic accuracy of the clinical criteria of pneumonia in detection of radiological pneumonia in children who are 1-5 years of age. KJMS. 2019;12(1):63.
Shrestha S, Chaudhary N, Pathak S, Sharma A, Shrestha L. Clinical predictors of radiological pneumonia”: A cross-sectional study from a tertiary hospital in Nepal. PLoS One. 2020;15(7):e0235598.
Lynch T, Platt R, Gouin S, Larson C, Patenaude Y. Can we predict which children with clinically suspected pneumonia will have the presence of focal infiltrates on chest radiographs? Pediatrics. 2004;113(3):e186-9.