马拉维利隆圭创新肺炎治疗项目中 2-59 月龄儿童的胸部 X 线摄影：二次分析。

Chest radiography in children aged 2-59 months enrolled in the Innovative Treatments in Pneumonia (ITIP) project in Lilongwe Malawi: a secondary analysis.

机构信息

Lilongwe Medical Relief Fund Trust, University of North Carolina Project, Lilongwe, Malawi.

Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.

出版信息

BMC Pediatr. 2022 Jan 10;22(1):31. doi: 10.1186/s12887-021-03091-3.

DOI:10.1186/s12887-021-03091-3

PMID:35012490

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8744340/

Abstract

BACKGROUND

Pneumonia is the leading infectious cause of death in children aged under 5 years in low- and middle-income countries (LMICs). World Health Organization (WHO) pneumonia diagnosis guidelines rely on non-specific clinical features. We explore chest radiography (CXR) findings among select children in the Innovative Treatments in Pneumonia (ITIP) project in Malawi in relation to clinical outcomes.

METHODS

When clinically indicated, CXRs were obtained from ITIP-enrolled children aged 2 to 59 months with community-acquired pneumonia hospitalized with treatment failure or relapse. ITIP1 (fast-breathing pneumonia) and ITIP2 (chest-indrawing pneumonia) trials enrolled children with non-severe pneumonia while ITIP3 enrolled children excluded from ITIP1 and ITIP2 with severe pneumonia and/or selected comorbidities. A panel of trained pediatricians classified the CXRs using the standardized WHO CXR research methodology. We analyzed the relationship between CXR classifications, enrollee characteristics, and outcomes.

RESULTS

Between March 2016 and June 2018, of 114 CXRs obtained, 83 met analysis criteria with 62.7% (52/83) classified as having significant pathology per WHO standardized interpretation. ITIP3 (92.3%; 12/13) children had a higher proportion of CXRs with significant pathology compared to ITIP1 (57.1%, 12/21) and ITIP2 (57.1%, 28/49) (p-value = 0.008). The predominant pathological CXR reading was "other infiltrates only" in ITIP1 (83.3%, 10/12) and ITIP2 (71.4%, 20/28), while in ITIP3 it was "primary endpoint pneumonia"(66.7%, 8/12,; p-value = 0.008). The percent of CXRs with significant pathology among children clinically cured (60.6%, 40/66) vs those not clinically cured (70.6%, 12/17) at Day 14 was not significantly different (p-value = 0.58).

CONCLUSIONS

In this secondary analysis we observed that ITIP3 children with severe pneumonia and/or selected comorbidities had a higher frequency of CXRs with significant pathology, although these radiographic findings had limited relationship to Day 14 outcomes. The proportion of CXRs with "primary endpoint pneumonia" was low. These findings add to existing data that additional diagnostics and prognostics are important for improving the care of children with pneumonia in LMICs.

TRIAL REGISTRATION

ITIP1, ITIP2, and ITIP3 were registered with ClinicalTrials.gov ( NCT02760420 , NCT02678195 , and NCT02960919 , respectively).

摘要

背景

肺炎是导致低收入和中等收入国家（LMICs）5 岁以下儿童死亡的主要传染病原因。世界卫生组织（WHO）的肺炎诊断指南依赖于非特异性临床特征。我们探讨了马拉维创新肺炎治疗（ITIP）项目中选定儿童的胸部 X 光（CXR）检查结果与临床结果的关系。

方法

当临床需要时，从因治疗失败或复发而住院的患有社区获得性肺炎的 ITIP 项目中年龄在 2 至 59 个月的入组儿童中获得 CXR。ITIP1（呼吸急促性肺炎）和 ITIP2（胸凹陷性肺炎）试验招募了患有非严重肺炎的儿童，而 ITIP3 则招募了患有严重肺炎和/或选择合并症的未被 ITIP1 和 ITIP2 招募的儿童。一组经过培训的儿科医生使用标准化的 WHO CXR 研究方法对 CXR 进行分类。我们分析了 CXR 分类、入组者特征和结局之间的关系。

结果

2016 年 3 月至 2018 年 6 月，共获得 114 份 CXR，其中 83 份符合分析标准，根据 WHO 标准化解释，62.7%（52/83）的 CXR 被分类为具有显著病理学。与 ITIP1（57.1%，12/21）和 ITIP2（57.1%，28/49）相比，ITIP3（92.3%，12/13）的儿童 CXR 中具有显著病理学的比例更高（p 值=0.008）。在 ITIP1（83.3%，10/12）和 ITIP2（71.4%，20/28）中，主要的 CXR 阅读结果为“其他浸润物仅”，而在 ITIP3 中则为“主要终点肺炎”（66.7%，8/12，p 值=0.008）。在第 14 天临床治愈（60.6%，40/66）的儿童与未临床治愈（70.6%，12/17）的儿童中，具有显著病理学的 CXR 比例无显著差异（p 值=0.58）。