Radiologic Diagnosis and Hospitalization among Children with Severe Community Acquired Pneumonia: A Prospective Cohort Study
Radiologic Diagnosis and Hospitalization among Children with Severe Community Acquired Pneumonia: A Prospective Cohort Study
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DOI：
10.1155/2019/6202405
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发表时间：
2019-01-01
影响因子：
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通讯作者：
Tadesse, Birkneh Tilahun
中科院分区：
文献类型：
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作者：
Hassen, Meiron;Toma, Alemayehu;Tadesse, Birkneh Tilahun
目标.本研究旨在评估胸部X光检查在诊断肺炎中的作用，并评估严重社区获得性肺炎儿童的临床特征与放射学检查结果和住院预测因素的相关性。方法.对2017年9月1日至11月30日诊断为重症肺炎的122名3个月至14岁儿童进行了前瞻性研究。符合条件的儿童接受胸部X线摄影，由两名高级放射科医生（R1和R2）独立阅读。R1和R2之间的分歧由第三名高级放射科医生（R3）解决。放射科医师之间的协议水平进行了评估，使用科恩的kappa系数。使用线性回归模式评估可以解释住院时间变异性的临床和实验室参数。独立的预测因素进行了评估，采用多元线性回归。结果队列的中位年龄为10.0个月（四分位距（IQR）：6.75-24.0）; 76例（62.3%）为男性。近一半，63（51.6%）没有肺炎的放射学证据。在报告实变（kappa=0.435，p值0.001）、模糊（kappa=0.375，p值0.001）和浸润（kappa=0.267，p值0.008）方面，R1和R2之间的一致性水平较低。记录体温较高的儿童更可能有提示肺炎的放射学异常（p值=0.033）。中位住院时间为3天（IQR：1-4天）; 118例（96.7%）好转出院。年龄别身高z评分（系数= 0.203，R-2=0.041，p值=0.027）和血红蛋白水平（系数=- 0.249，R-2=0.062，p值=0.006）分别解释了住院时间变异性的4.1%和6.2%。结论在半数重症肺炎患儿中，没有肺炎的放射学证据。高级放射科医生在报告胸部X线检查结果方面的一致性较低，可能需要协调活动，以统一执行阅读胸部X线片的WHO指南。
Objectives. This study was designed to assess the role of chest radiography for the diagnosis of pneumonia and assess the association of clinical characteristics with radiologic findings and predictors of hospitalization among children with severe community acquired pneumonia. Methods. A prospective study was conducted on 122 children between ages of 3 month and 14 years admitted to pediatric emergency unit with diagnosis of severe pneumonia from September 1st to November 30th, 2017. Eligible children were subjected to chest radiography which was read by two senior radiologists independently (R1 and R2). Disagreements between R1 and R2 were resolved by a third senior radiologist (R3). Level of agreement between radiologists was assessed using Cohen's kappa coefficient. Clinical and laboratory parameters which could explain the variability in the duration of hospital stay were assessed using a linear regression mode. Independent predictors were assessed using multiple linear regression. Results. The median age of the cohort was 10.0 months (interquartile range (IQR): 6.75-24.0); 76 (62.3%) were male. Nearly half, 63 (51.6%) did not have radiologic evidence of pneumonia. There was low level of agreement between R1 and R2 in reporting consolidation (kappa=0.435, p-value0.001), haziness (kappa=0.375, p-value0.001), and infiltration (kappa=0.267, p-value=0.008). Children with higher recorded temperature were more likely to have radiologic abnormalities suggesting pneumonia (p-value=0.033). The median duration of hospitalization was 3 days (IQR: 1-4 days); 118 (96.7%) were discharged with improvement. Height-for-age z-score (Coef.=0.203, R-2=0.041, p-value=0.027); and hemoglobin level (Coef.=-0.249, R-2=0.062, p-value=0.006) explained 4.1% and 6.2% of the variability in the duration of hospital stay, respectively. Conclusion. Radiologic evidence of pneumonia was absent in half of the children with severe pneumonia. There was low agreement between senior radiologists in reporting chest radiographic findings, potentially necessitating harmonization activities to uniformly implement the WHO guidelines in reading chest radiographs.