Chest radiograph findings in childhood pneumonia cases from the multisite PERCH study

PERCH Study Group

Research output: Contribution to journalArticle

Abstract

Background. 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. Methods. 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. Results. 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. Conclusions. 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.

Original languageEnglish (US)
Pages (from-to)S262-S270
JournalClinical Infectious Diseases
Volume64
DOIs
StatePublished - Jan 1 2017

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Pneumonia
Thorax
Gambia
Mali
Zambia
Tachypnea
Bangladesh
Kenya
Respiratory Sounds
Thailand
South Africa
Health Personnel
Fever
Research

Keywords

  • Chest radiograph
  • Mortality
  • Pediatrics
  • Pneumonia
  • Signs and symptoms

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

Chest radiograph findings in childhood pneumonia cases from the multisite PERCH study. / PERCH Study Group.

In: Clinical Infectious Diseases, Vol. 64, 01.01.2017, p. S262-S270.

Research output: Contribution to journalArticle

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title = "Chest radiograph findings in childhood pneumonia cases from the multisite PERCH study",
abstract = "Background. 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. Methods. 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. Results. 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. Conclusions. 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.",
keywords = "Chest radiograph, Mortality, Pediatrics, Pneumonia, Signs and symptoms",
author = "{PERCH Study Group} and Nicholas Fancourt and Knoll, {Maria Deloria} and Baggett, {Henry C.} and Brooks, {W Abdullah} and Daniel Feikin and Hammitt, {Laura L} and Howie, {Stephen R.C.} and Kotloff, {Karen L.} and Levine, {Orin S.} and Madhi, {Shabir A.} and Murdoch, {David R.} and Scott, {J. Anthony G.} and Thea, {Donald M.} and Awori, {Juliet O.} and Breanna Barger-Kamate and James Chipeta and Andrea Deluca and Mahamadou Diallo and Driscoll, {Amanda J.} and Ebruke, {Bernard E.} and Melissa Higdon and Yasmin Jahan and Karron, {Ruth A} and Nasreen Mahomed and Moore, {David P.} and Kamrun Nahar and Sathapana Naorat and Ominde, {Micah Silaba} and Park, {Daniel E.} and Christine Prosperi and Somwe, {Somwe Wa} and Somsak Thamthitiwat and Zaman, {Syed M.A.} and Scott Zeger and O'Brien, {Katherine L} and Wei Fu and Kagucia, {Eunice Wangeci} and Mengying Li and Zhenke Wu and Watson, {Nora L.} and Jane Crawley and Endtz, {Hubert P.} and Khalequ Zaman and Doli Goswami and Lokman Hossain and Hasan Ashraf and Martin Antonio and Jessica McLellan and Eunice Machuka and Arifin Shamsul",
year = "2017",
month = "1",
day = "1",
doi = "10.1093/cid/cix089",
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TY - JOUR

T1 - Chest radiograph findings in childhood pneumonia cases from the multisite PERCH study

AU - PERCH Study Group

AU - Fancourt, Nicholas

AU - Knoll, Maria Deloria

AU - Baggett, Henry C.

AU - Brooks, W Abdullah

AU - Feikin, Daniel

AU - Hammitt, Laura L

AU - Howie, Stephen R.C.

AU - Kotloff, Karen L.

AU - Levine, Orin S.

AU - Madhi, Shabir A.

AU - Murdoch, David R.

AU - Scott, J. Anthony G.

AU - Thea, Donald M.

AU - Awori, Juliet O.

AU - Barger-Kamate, Breanna

AU - Chipeta, James

AU - Deluca, Andrea

AU - Diallo, Mahamadou

AU - Driscoll, Amanda J.

AU - Ebruke, Bernard E.

AU - Higdon, Melissa

AU - Jahan, Yasmin

AU - Karron, Ruth A

AU - Mahomed, Nasreen

AU - Moore, David P.

AU - Nahar, Kamrun

AU - Naorat, Sathapana

AU - Ominde, Micah Silaba

AU - Park, Daniel E.

AU - Prosperi, Christine

AU - Somwe, Somwe Wa

AU - Thamthitiwat, Somsak

AU - Zaman, Syed M.A.

AU - Zeger, Scott

AU - O'Brien, Katherine L

AU - Fu, Wei

AU - Kagucia, Eunice Wangeci

AU - Li, Mengying

AU - Wu, Zhenke

AU - Watson, Nora L.

AU - Crawley, Jane

AU - Endtz, Hubert P.

AU - Zaman, Khalequ

AU - Goswami, Doli

AU - Hossain, Lokman

AU - Ashraf, Hasan

AU - Antonio, Martin

AU - McLellan, Jessica

AU - Machuka, Eunice

AU - Shamsul, Arifin

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Background. 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. Methods. 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. Results. 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. Conclusions. 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.

AB - Background. 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. Methods. 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. Results. 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. Conclusions. 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.

KW - Chest radiograph

KW - Mortality

KW - Pediatrics

KW - Pneumonia

KW - Signs and symptoms

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U2 - 10.1093/cid/cix089

DO - 10.1093/cid/cix089

M3 - Article

C2 - 28575361

AN - SCOPUS:85021939125

VL - 64

SP - S262-S270

JO - Clinical Infectious Diseases

JF - Clinical Infectious Diseases

SN - 1058-4838

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