Concerns about Consensus Statement on Chest Imaging in Pediatric COVID-19 Patient Management
2020; Radiological Society of North America; Volume: 2; Issue: 3 Linguagem: Inglês
10.1148/ryct.2020200305
ISSN2638-6135
AutoresSarah M. Desoky, Savvas Andronikou, Alan S. Brody, W. Hirsch,
Tópico(s)Pericarditis and Cardiac Tamponade
ResumoHomeRadiology: Cardiothoracic ImagingVol. 2, No. 3 PreviousNext Letters to the EditorFree AccessConcerns about Consensus Statement on Chest Imaging in Pediatric COVID-19 Patient ManagementSarah M. Desoky,* , Savvas Andronikou†, Alan S. Brody‡, Franz Wolfgang Hirsch§Sarah M. Desoky,* , Savvas Andronikou†, Alan S. Brody‡, Franz Wolfgang Hirsch§Author AffiliationsDepartments of Medical Imaging and Pediatrics, University of Arizona College of Medicine–Tucson, 1501 N Campbell Ave, Tucson, AZ 85724*Department of Radiology, The Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa†Department of Radiology and Medical Imaging, Cincinnati Children's Hospital and the University of Cincinnati College of Medicine, Cincinnati, Ohio‡Institute for Pediatric Radiology, Leipzig University, Leipzig, Germany§e-mail: [email protected]Sarah M. Desoky,* Savvas Andronikou†Alan S. Brody‡Franz Wolfgang Hirsch§Published Online:Jun 25 2020https://doi.org/10.1148/ryct.2020200305MoreSectionsPDF ToolsAdd to favoritesCiteTrack Citations ShareShare onFacebookXLinked In Editor:We are writing to express concerns about the recently published "International Expert Consensus Statement on Chest Imaging in Pediatric COVID-19 Patient Management: Imaging Findings, Imaging Study Reporting, and Imaging Study Recommendations" by Foust and colleagues (1) in the April 2020 issue of Radiology: Cardiothoracic Imaging, which has been widely disseminated. We would like to make readers aware of the following limitations.The title and Methods section suggest the statement reflects a broad-based consensus representing more than author opinions. "Expert consensus statement" implies review by recognized organizations and widespread expert agreement, rather than nine self-selected radiologists who conducted a literature review and participated in a single conference call. The authors state they are "current active members" of six international pediatric radiology societies, giving the impression that these organizations support their views; however, this article was neither reviewed nor endorsed by the Society for Pediatric Radiology or the European Society of Paediatric Radiology. Collaborating with international societies would be prudent to avoid circulating potentially conflicting messages.The article contains recommendations that are unsupported. The authors recommend structured reporting, classifying findings as "typical," "indeterminate," and "atypical" for coronavirus disease 2019 (COVID-19). For chest radiographs, the authors base their recommendations on a single published report of 10 cases (2). The authors include peribronchial thickening as a finding in the "indeterminate" category for chest radiographs, supported by a publication that reviewed only CT findings (3). Instead, larger collaborative studies of pediatric COVID-19 imaging should inform these recommendations. In a review of 91 pediatric patients with COVID-19 (81 with chest radiographs), submitted to Pediatric Radiology and under revision,*, the broad range of findings on chest radiographs in COVID-19 did not allow such stratification of findings.The article contains unsupported statements that could affect decision-making and interpretation of imaging studies. "There are differences emerging in imaging features between pediatric and adult cases...of which both radiologists and referring physicians should be aware" suggests that knowledge of these differences is necessary to best care for children with COVID-19; however, insufficient data are provided to support this statement. A misleading statement on radiation risk, always a consideration when deciding whether to utilize CT, may result in inappropriate and potentially medically negligent care if it results in avoidance of advanced imaging in a potentially life-threatening illness due to fear of radiation.Disclosures of Conflicts of Interest: S.M.D. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: disclosed no relevant relationships. Other relationships: coauthored a manuscript on imaging findings in pediatric COVID-19 which has been submitted and revised/resubmitted to Pediatric Radiology journal. S.A. disclosed no relevant relationships. A.S.B. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: author is consultant for Vertex Pharmaceuticals (study design for cystic fibrosis trials using imaging); institution received grants from Vertex Pharmaceuticals (analysis of CT scanning in 2–6-year-old children with cystic fibrosis). Other relationships: disclosed no relevant relationships. F.W.H. disclosed no relevant relationships.* Review since published in Pediatric RadiologyReferences1. Foust AM, Phillips GS, Chu WC, et al. International Expert Consensus Statement on Chest Imaging in Pediatric COVID-19 Patient Management: Imaging Findings, Imaging Study Reporting, and Imaging Study Recommendations. Radiol Cardiothorac Imaging 2020;2(2):e200214. Link, Google Scholar2. Cai J, Xu J, Lin D, et al. A Case Series of children with 2019 novel coronavirus infection: clinical and epidemiological features. Clin Infect Dis 2020. 10.1093/cid/ciaa198. Published online February 28, 2020. PubMed Google Scholar3. Chen A, Huang J, Liao Y, et al. Differences in Clinical and Imaging Presentation of Pediatric Patients with COVID-19 in Comparison with Adults. Radiol Cardiothorac Imaging 2020;2(2):e200117. Link, Google ScholarReferences1. Santos JF. Acute chest diseases: infection and trauma. In: Garcia-Peña P, Guillerman RP, eds. Pediatric chest imaging. 3rd ed. Berlin, Germany: Springer, 2014; 267–283. Crossref, Google Scholar2. Liszewski MC, Laya BF, Zucker EJ, Restrepo R, Lee EY. Lung. In: Lee EY, ed. Pediatric thoracic imaging. Philadelphia, Pa: Wolters Kluwer, 2019; 1–113. Google Scholar3. Chu WC, Li AM, Ng AW, et al. Thin-section CT 12 months after the diagnosis of severe acute respiratory syndrome in pediatric patients. AJR Am J Roentgenol 2006;186(6):1707–1714. Crossref, Medline, Google Scholar4. Das KM, Lee EY, Langer RD, Larsson SG. Middle East respiratory syndrome coronavirus: what does a radiologist need to know? AJR Am J Roentgenol 2016;206(6):1193–1201. Crossref, Medline, Google Scholar5. Foust AM, Winant AJ, Chu WC, Das KM, Phillips GS, Lee EY. Pediatric SARS, H1N1, MERS, EVALI, and now coronavirus disease (COVID-19) pneumonia: what radiologists need to know. AJR Am J Roentgenol 2020;30:1–9. Crossref, Google ScholarReferences1. Foust AM, Phillips GS, Chu WC, et al. International Expert Consensus Statement on Chest Imaging in Pediatric COVID-19 Patient Management: Imaging Findings, Imaging Study Reporting, and Imaging Study Recommendations. Radiol Cardiothorac Imaging 2020;2(2):e200214. Link, Google Scholar2. Cai J, Xu J, Lin D, et al. A Case Series of children with 2019 novel coronavirus infection: clinical and epidemiological features. Clin Infect Dis 2020. 10.1093/cid/ciaa198. Published online February 28, 2020. PubMed Google Scholar3. Chen A, Huang J, Liao Y, et al. Differences in Clinical and Imaging Presentation of Pediatric Patients with COVID-19 in Comparison with Adults. Radiol Cardiothorac Imaging 2020;2(2):e200117. Link, Google ScholarResponseAlexandra M. Foust*, Grace S. Phillips†, Winnie C. Chu‡, Pedro Daltro§, Karuna M. Dasǁ, Pilar Garcia-Peña#, Tracy Kilborn**, Abbey J. Winant*, Edward Y. Lee* Alexandra M. Foust*, Grace S. Phillips†, Winnie C. Chu‡, Pedro Daltro§, Karuna M. Dasǁ, Pilar Garcia-Peña#, Tracy Kilborn**, Abbey J. Winant*, Edward Y. Lee* Author AffiliationsDepartment of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115*Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Wash†Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China‡Alta Excelência Diagnóstica and Department of Radiology, Clínica Diagnóstico por Imagem (CDPI), Rio de Janeiro, Brazil§Department of Radiology, College of Medicine and Health Sciences, Al Ain, United Arab EmiratesǁDepartment of Pediatric Radiology, University Hospital Materno-Infantil Vall d'Hebron, Barcelona, Spain#Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa**e-mail: [email protected]The COVID-19 pandemic brought unprecedented uncertainty. Such uncertainty is particularly challenging for radiologists, who are on the front lines interpreting imaging studies that play an essential role in managing pediatric patients with COVID-19. At the time that our article was published at the end of April, and even now, only limited data related to the imaging findings of pediatric COVID-19 were available, a limitation that is clearly stated in our article.In this era of uncertainty due to COVID-19, there are various potential approaches to creating resources in this uncharted territory. With limited data, one cautious approach may be to wait for all scientific evidence. However, this would require standing still in the face of great need, during a global health crisis. A different approach might be to face the uncertainty of COVID-19 by investigating the next best practice, which may be, by many measures, a more prudent alternative. Before submission of our article, we disclosed to the journal the lack of endorsement by specific radiologic societies. However, in the setting of limited data, widely used textbooks (1,2) as well as knowledge from investigators whose previous scientific work focused on other coronavirus infections (3–5), are crucial to further our understanding of this novel infection. Our article is a response to pleas from many struggling radiologists and clinicians for some guidance on the pediatric imaging findings of COVID-19, based on available resources and our collective experience with pediatric COVID-19 after extensive discussions among the authors.Prompt dissemination of important new findings during times of uncertainty is essential for advances in knowledge and management. Therefore, in collaboration with the World Federation of Pediatric Imaging (WFPI), another international collaborative study on perceived impact of COVID-19 on pediatric radiology departments around the world in addition to our group's investigation on thoracic imaging findings of multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19 are now available via Radiology: Cardiothoracic Imaging journal.We also believe that success in this time of pandemic crisis and uncertainty requires collaborative efforts among international experts as well as local, national, and international societies. Such concerted efforts can strengthen our courage and conviction to overcome this unique challenge together. Disclosures of Conflicts of Interest: A.M.F. disclosed no relevant relationships. G.S.P. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: author received $1000 travel stipend for lecturing at the International Society of Computed Tomography 2019 annual meeting (September 2019). Other relationships: disclosed no relevant relationships. W.C.C. disclosed no relevant relationships. P.D. disclosed no relevant relationships. K.M.D. disclosed no relevant relationships. P.G.P. disclosed no relevant relationships. T.K. disclosed no relevant relationships. A.J.W. disclosed no relevant relationships. E.Y.L. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: author provides expert testimony (pediatric radiology related medical expert work); author received speaker traveling support and honorarium from Guerbet; author receives textbook royalties from publishers as an editor. Other relationships: disclosed no relevant relationships.References1. Santos JF. Acute chest diseases: infection and trauma. In: Garcia-Peña P, Guillerman RP, eds. Pediatric chest imaging. 3rd ed. Berlin, Germany: Springer, 2014; 267–283. Crossref, Google Scholar2. Liszewski MC, Laya BF, Zucker EJ, Restrepo R, Lee EY. Lung. In: Lee EY, ed. Pediatric thoracic imaging. Philadelphia, Pa: Wolters Kluwer, 2019; 1–113. Google Scholar3. Chu WC, Li AM, Ng AW, et al. Thin-section CT 12 months after the diagnosis of severe acute respiratory syndrome in pediatric patients. AJR Am J Roentgenol 2006;186(6):1707–1714. Crossref, Medline, Google Scholar4. Das KM, Lee EY, Langer RD, Larsson SG. Middle East respiratory syndrome coronavirus: what does a radiologist need to know? AJR Am J Roentgenol 2016;206(6):1193–1201. Crossref, Medline, Google Scholar5. Foust AM, Winant AJ, Chu WC, Das KM, Phillips GS, Lee EY. Pediatric SARS, H1N1, MERS, EVALI, and now coronavirus disease (COVID-19) pneumonia: what radiologists need to know. AJR Am J Roentgenol 2020;30:1–9. 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