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

Clin Infect Dis. 2017 Jun 15;64(suppl_3):S262-S270. doi: 10.1093/cid/cix089.

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.

Publication types

  • Multicenter Study

MeSH terms

  • Australia
  • Bangladesh
  • Child Health
  • Child, Preschool
  • Female
  • Gambia
  • Humans
  • Infant
  • Infant, Newborn
  • Internationality
  • Kenya
  • Male
  • Mali
  • Pneumonia / diagnostic imaging*
  • Pneumonia / epidemiology
  • Pneumonia / etiology*
  • Pneumonia / mortality
  • Pneumonia, Bacterial / diagnostic imaging
  • Pneumonia, Bacterial / epidemiology
  • Pneumonia, Viral / diagnostic imaging
  • Pneumonia, Viral / epidemiology
  • Radiography, Thoracic*
  • South Africa
  • Thailand
  • World Health Organization
  • Zambia