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

2017; Oxford University Press; Volume: 64; Issue: suppl_3 Linguagem: Inglês

10.1093/cid/cix089

1537-6591

Nicholas Fancourt, Maria Deloria Knoll, Henry C. Baggett, W. Abdullah Brooks, Daniel R. Feikin, Laura L. Hammitt, Stephen R. C. Howie, Karen L. Kotloff, Orin S. Levine, Shabir A. Madhi, David R. Murdoch, J. Anthony G. Scott, Donald M. Thea, Juliet O. Awori, Breanna Barger-Kamate, James Chipeta, Andrea N. DeLuca, Mahamadou Diallo, Amanda J. Driscoll, Bernard E. Ebruke, Melissa M. Higdon, Yasmin Jahan, Ruth A. Karron, Nasreen Mahomed, David P. Moore, Kamrun Nahar, Sathapana Naorat, Micah Silaba Ominde, Daniel E. Park, Christine Prosperi, Somwe Wa Somwe, Somsak Thamthitiwat, Syed M. A. Zaman, Scott L. Zeger, Katherine L. O’Brien, Katherine L. O’Brien, Orin S. Levine, Maria Deloria Knoll, Daniel R. Feikin, Andrea N. DeLuca, Amanda J. Driscoll, Nicholas Fancourt, Wei Fu, Laura L. Hammitt, Melissa M. Higdon, E. Wangeci Kagucia, Ruth A. Karron, Mengying Li, Daniel E. Park, Christine Prosperi, Zhenke Wu, Scott L. Zeger, Nora L. Watson, Jane Crawley, David R. Murdoch, W. Abdullah Brooks, Hubert P. Endtz, Khalequ Zaman, Doli Goswami, Lokman Hossain, Yasmin Jahan, Hasan Ashraf, Stephen R. C. Howie, Bernard E. Ebruke, Martín Antonio, Jessica McLellan, Eunice Machuka, Arifin Shamsul, Syed M. A. Zaman, Grant Mackenzie, J. Anthony G. Scott, Juliet O. Awori, Susan C. Morpeth, Alice Kamau, Sidi Kazungu, Micah Silaba Ominde, Karen L. Kotloff, Milagritos D. Tapia, Samba O. Sow, Mamadou Sylla, Boubou Tamboura, Uma Onwuchekwa, Nana Kourouma, Aliou Touré, Shabir A. Madhi, David P. Moore, Peter V. Adrian, Vicky L. Baillie, Locadiah Kuwanda, Azwifarwi Mudau, Michelle J. Groome, Nasreen Mahomed, Henry C. Baggett, Somsak Thamthitiwat, Susan A. Maloney, Charatdao Bunthi, Julia Rhodes, Pongpun Sawatwong, Pasakorn Akarasewi, Donald M. Thea, Lawrence Mwananyanda, James Chipeta, Phil Seidenberg, James Mwansa, Somwe Wa Somwe, Geoffrey Kwenda,

Emergency and Acute Care Studies

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.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.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.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.