Kin Key Ng, Araújo-Neto César Augusto, Nascimento-Carvalho Cristiana Maria
Department of Pediatrics, Federal University of Bahia School of Medicine, Salvador, Bahia, Brazil.
Pediatr Pulmonol. 2009 Mar;44(3):249-52. doi: 10.1002/ppul.20988.
To assess if chest radiographic findings present on admission are associated with severity of childhood community-acquired pneumonia (CAP), a total of 161 children hospitalized with pulmonary infiltrate were enrolled in the study; 48 (30%) patients were excluded because of presence of bilateral chest radiographic alterations (33; 20%) and presence of underlying diseases (15; 9%). According to WHO and BTS criteria, severe CAP was present in 57 (50%) and in 96 (85%) cases, respectively; 29 (26%) were aged less than 1 year. The median age (months) was 22 (mean 24 +/- 14, range 2-58). Overall, radiographic finding was right-sided in 77 (68%) cases and the upper lobe was compromised in 36 (32%) cases. By analyzing data stratified to age, the frequency of upper lobe involvement was significantly higher among severe cases (WHO criteria) only for those patients aged > or =1 year (13/35 [37%] vs. 7/45 [16%], P = 0.03, OR [95% CI] 3.2 [1.1-9.2]). The specificity and positive predictive value of upper lobe involvement for severity among the latter group of patients were 84% (95% CI 70-93%) and 65% (95% CI 41-84%), respectively. No association was found by using the BTS criteria. The admission chest radiography was useful to predict severity of children aged > or =1 year hospitalized with CAP.
为评估入院时胸部X线检查结果是否与儿童社区获得性肺炎（CAP）的严重程度相关，本研究共纳入了161例因肺部浸润而住院的儿童；48例（30%）患者因存在双侧胸部X线改变（33例；20%）和存在基础疾病（15例；9%）而被排除。根据世界卫生组织（WHO）和英国胸科学会（BTS）标准，分别有57例（50%）和96例（85%）为重症CAP；29例（26%）年龄小于1岁。中位年龄（月）为22（平均24±14，范围2 - 58）。总体而言，77例（68%）病例的X线表现为右侧，36例（32%）病例的上叶受累。通过分析按年龄分层的数据，仅在年龄≥1岁的患者中，重症病例（WHO标准）中上叶受累的频率显著更高（13/35 [37%] 对7/45 [16%]，P = 0.03，OR [95% CI] 3.2 [1.1 - 9.2]）。后一组患者中上叶受累对严重程度的特异性和阳性预测值分别为84%（95% CI 70 - 93%）和65%（95% CI 41 - 84%）。使用BTS标准未发现相关性。入院时的胸部X线检查有助于预测因CAP住院的年龄≥1岁儿童的严重程度。
