Shim Moon Ki, Park Ji Eun, Jeon Hyelynn, Park Bumhee, Kim Jung Heon
Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Republic of Korea.
Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Pediatr Pulmonol. 2025 Jan;60(1):e27458. doi: 10.1002/ppul.27458. Epub 2024 Dec 23.
To investigate the clinical implications of the obstructive pattern on plain chest radiography, defined as peribronchial cuffing or hyperinflation, in young children with severe lower respiratory tract infections (LRTIs).
We reviewed all children aged 3‒59 months with LRTIs who underwent radiography and polymerase chain reaction in a Korean emergency department from 2016 through 2020. The radiographs were read as consolidation, peribronchial cuffing, or hyperinflation, with each interrater reliability computed. As per the obstructive pattern, we compared their clinical features, therapeutic interventions, outcomes, and microbiology.
Among 599 children with LRTIs, 465 were enrolled, of whom 98 (21.1%) had consolidation (κ = 0.60; 95% confidence interval, 0.50‒0.70), and 367 (78.9%) had peribronchial cuffing (0.55; 0.46‒0.65) or hyperinflation (0.59; 0.52‒0.67). The obstructive pattern was significantly associated with more frequent wheezing (obstructive, 28.6% vs. consolidation, 10.2%) and the use of inhaled albuterol or systemic steroids (39.0% vs. 23.5%), and lower median values or frequencies of age (22.0 vs. 35.0 months), crackle or diminished breath sound (42.0% vs. 61.2%), C-reactive protein (1.4 vs. 2.9 mg/dL), antibiotic therapy (72.2% vs. 93.9%), length of hospital stay (4.0 vs 5.0 days), fever lasting 3 days or longer (7.9% vs. 29.6%), and complications (0.5% vs. 9.2%). Microbiologically, viruses, such as respiratory syncytial virus, were more frequently detected in children with the obstructive pattern or at a younger age.
This study confirms an association of the obstructive pattern on radiography with viral infection and inflammatory airway obstruction-relieving therapy in young children with severe LRTIs.
探讨胸部X线平片上阻塞性表现（定义为支气管周围袖口征或肺过度充气）在患有严重下呼吸道感染（LRTIs）的幼儿中的临床意义。
我们回顾了2016年至2020年在韩国一家急诊科接受X线检查和聚合酶链反应的所有3至59个月大的LRTIs患儿。X线片被解读为实变、支气管周围袖口征或肺过度充气，并计算了各阅片者之间的可靠性。根据阻塞性表现，我们比较了他们的临床特征、治疗干预措施、结局和微生物学情况。
在599例LRTIs患儿中，465例被纳入研究，其中98例（21.1%）有实变（κ = 0.60；95%置信区间，0.50至0.70），367例（78.9%）有支气管周围袖口征（0.55；0.46至0.65）或肺过度充气（0.59；0.52至0.67）。阻塞性表现与更频繁的喘息（阻塞性，28.6% vs. 实变，10.2%）以及吸入沙丁胺醇或全身用类固醇的使用（39.0% vs. 23.5%）显著相关，且年龄中位数或频率更低（22.0 vs. 35.0个月）、啰音或呼吸音减弱（42.0% vs. 61.2%）、C反应蛋白（1.4 vs. 2.9mg/dL）、抗生素治疗（72.2% vs. 93.9%）、住院时间（4.0 vs 5.0天）、发热持续3天或更长时间（7.9% vs. 29.6%）以及并发症（0.5% vs. 9.2%）。在微生物学方面，呼吸道合胞病毒等病毒在有阻塞性表现的患儿或年龄较小的患儿中更频繁地被检测到。
本研究证实了胸部X线平片上的阻塞性表现与患有严重LRTIs的幼儿的病毒感染及缓解炎症性气道阻塞的治疗之间的关联。
