Fancourt Nicholas, Deloria Knoll Maria, Baggett Henry C, Brooks W Abdullah, Feikin Daniel R, Hammitt Laura L, Howie Stephen R C, Kotloff Karen L, Levine Orin S, Madhi Shabir A, Murdoch David R, Scott J Anthony G, Thea Donald M, Awori Juliet O, Barger-Kamate Breanna, Chipeta James, DeLuca Andrea N, Diallo Mahamadou, Driscoll Amanda J, Ebruke Bernard E, Higdon Melissa M, Jahan Yasmin, Karron Ruth A, Mahomed Nasreen, Moore David P, Nahar Kamrun, Naorat Sathapana, Ominde Micah Silaba, Park Daniel E, Prosperi Christine, Wa Somwe Somwe, Thamthitiwat Somsak, Zaman Syed M A, Zeger Scott L, O'Brien Katherine L
Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Murdoch Children's Research Institute and.
Clin Infect Dis. 2017 Jun 15;64(suppl_3):S262-S270. doi: 10.1093/cid/cix089.
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.
胸部X光片（CXR）常用于评估肺炎病例。不同流行病学背景下CXR表现的差异及其与临床体征的相关性尚无充分记录。
儿童健康肺炎病因研究项目纳入了来自7个国家（孟加拉国、冈比亚、肯尼亚、马里、南非、泰国和赞比亚）9个地点的4232例世界卫生组织（WHO）定义的重度和极重度肺炎住院病例。入院时，由经过培训的卫生人员对每个病例进行临床体征和肺炎危险因素的标准化评估，并拍摄一张CXR，使用WHO标准化方法进行解读。CXR分为异常（实变和/或其他浸润）、正常或无法解读。
3587例（85%）病例的CXR可解读，其中1935例（54%）异常（各地点范围为35%-64%）。CXR异常的病例比CXR正常的病例更易出现低氧血症（45%对26%）、啰音（69%对62%）、呼吸急促（85%对80%）或发热（20%对16%），而出现喘息的可能性较小（30%对38%；所有P<0.05）。与其他浸润（4.7%）或正常（4.9%）的CXR相比，CXR实变在30天随访时的病死率更高（13.5%）。
临床诊断为肺炎且CXR异常的病例更易出现通常与肺炎相关的体征。然而，CXR正常的病例很常见，且这些病例中有相当比例存在被认为可指示肺炎的临床体征。CXR实变的病例在出院后30天死亡可能性增加。
