Radiologic Diagnosis and Hospitalization among Children with Severe Community Acquired Pneumonia: A Prospective Cohort Study

Author:

Hassen Meiron12,Toma Alemayehu3,Tesfay Mulugeta4,Degafu Eyoel5,Bekele Solomon6,Ayalew Freshwork7,Gedefaw Abel8,Tadesse Birkneh Tilahun2ORCID

Affiliation:

1. Adare General Hospital, Pediatrics Unit, Hawassa, Ethiopia

2. Hawassa University, College of Medicine and Health Sciences, Department of Pediatrics and Child health, Hawassa, P.O. Box 1560, Ethiopia

3. Hawassa University, College of Medicine and Health Sciences, School of Pharmacy, Department of Pharmacology and Toxicology, Hawassa, P.O. Box 1560, Ethiopia

4. Bete-Abrham Primary Hospital, Department of Radiology, Hawassa, P.O. Box 851, Ethiopia

5. Alatyon General Hospital, Department of Radiology, Hawassa, P.O. Box 1267, Ethiopia

6. Hawassa University, College of Medicine and Health Sciences, Department of Radiology, Hawassa, P.O. Box 1560, Ethiopia

7. Hawassa University, College of Medicine and Health Sciences, School of Laboratory Medicine, Hawassa, P.O. Box 1560, Ethiopia

8. Hawassa University, College of Medicine and Health Sciences, Department of Gynecology and Obstetrics, Hawassa, P.O. Box 1560, Ethiopia

Abstract

Objectives. 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. Methods. 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 1st to November 30th, 2017. Eligible children were subjected to chest radiography which was read by two senior radiologists independently (R1 and R2). Disagreements between R1 and R2 were resolved by a third senior radiologist (R3). 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. Results. 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 R1 and R2 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, R2=0.041, p-value=0.027); and hemoglobin level (Coef.=-0.249, R2=0.062, p-value=0.006) explained 4.1% and 6.2% of the variability in the duration of hospital stay, respectively. Conclusion. 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.

Funder

Hawassa University

Publisher

Hindawi Limited

Subject

General Immunology and Microbiology,General Biochemistry, Genetics and Molecular Biology,General Medicine

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