Adare General Hospital, Pediatrics Unit, Hawassa, Ethiopia.
Hawassa University, College of Medicine and Health Sciences, Department of Pediatrics and Child health, Hawassa, P.O. Box 1560, Ethiopia.
Biomed Res Int. 2019 Jan 9;2019:6202405. doi: 10.1155/2019/6202405. eCollection 2019.
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.
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 1 to November 30, 2017. Eligible children were subjected to chest radiography which was read by two senior radiologists independently ( and ). Disagreements between and were resolved by a third senior radiologist (). 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.
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 and in reporting consolidation (kappa=0.435, p-value≤0.001), haziness (kappa=0.375, p-value≤0.001), 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=0.041, p-value=0.027); and hemoglobin level (Coef.=-0.249, R=0.062, p-value=0.006) explained 4.1% and 6.2% of the variability in the duration of hospital stay, respectively.
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.
本研究旨在评估胸部 X 线摄影在肺炎诊断中的作用，并评估临床特征与影像学表现之间的关系，以及预测严重社区获得性肺炎患儿住院的因素。
对 2017 年 9 月 1 日至 11 月 30 日因严重肺炎入住儿科急诊单元的 122 名 3 个月至 14 岁儿童进行前瞻性研究。对符合条件的儿童进行胸部 X 线摄影，由两名资深放射科医生独立进行（和）。如果和之间存在分歧，则由第三名资深放射科医生（）进行解决。使用 Cohen 的 kappa 系数评估放射科医生之间的一致性水平。使用线性回归模型评估可能解释住院时间差异的临床和实验室参数。使用多元线性回归评估独立预测因素。
该队列的中位年龄为 10.0 个月（四分位距（IQR）：6.75-24.0）；76 名（62.3%）为男性。近一半（63 名，51.6%）没有放射学证据表明患有肺炎。和在报告实变（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）方面的一致性水平较低。记录的体温较高的儿童更有可能出现放射学异常提示肺炎（p 值=0.033）。住院中位时间为 3 天（IQR：1-4 天）；118 名（96.7%）经改善后出院。身高年龄 z 评分（Coef.=0.203，R=0.041，p 值=0.027）和血红蛋白水平（Coef.=-0.249，R=0.062，p 值=0.006）分别解释了住院时间差异的 4.1%和 6.2%。
一半患有严重肺炎的儿童胸部 X 线摄影无肺炎证据。两名资深放射科医生在报告胸部 X 线摄影结果方面的一致性水平较低，可能需要开展协调活动，以统一实施世卫组织阅读胸部 X 线片的指南。
