Role of Chest X-ray, Inflammatory Markers and Blood Gases for Diagnosis and Assessment of Severity in Childhood Pneumonia: A Cross-sectional Study

Abstract

Introduction: Pneumonia is one of the leading causes of morbidity and mortality in under-five children. The utility of simple clinical signs forms the basis of early diagnosis and treating children with pneumonia. Inflammatory markers along with chest X-rays further help to differentiate between viral and bacterial causes and also help in the assessment of the severity of infections. Aim: To find out the clinical spectrum, haematological and radiological parameters of the children admitted with Community-Acquired Pneumonia (CAP) and to correlate the findings with the disease severities. Materials and Methods: The present study was an observational, cross-sectional study done for the period of one year i.e. from July 2017 to June 2018 in the Department of Paediatrics, of RG Kar Medical College, Kolkata , West Bengal, India. A total of 100 children aged two months to five years suffering from severe pneumonia and very severe pneumonia according to World Health Organisation (WHO) definition. They underwent a complete physical examination. Routine radiological and haematological investigations were done. The children were managed using a standard protocol. They were closely followed-up for the need for change in antibiotics, prolonged hospital stay, need for mechanical ventilation, and mortality. All data were collected and subjected to statistical analysis with the help of Statistical Package for the Social Sciences (SPSS) Software (version 17.0). A p-value <0.05 was considered to be statistically significant. Results: Out of 100 children, bronchopneumonia (72%) was the most common clinical diagnosis made at admission. Hurried breathing, cough, and fever were presenting features in most of the cases. According to WHO, the Acute Respiratory Infection (ARI) control program, 62% had severe pneumonia and 38% had very severe pneumonia. On investigation, radiological findings had high sensitivity and specificity to clinical findings. Inflammatory markers {C-Reactive Protein (CRP) >15.7 mg/dL and Erythrocyte Sedimentation Rate (ESR) >20 mm/hr} were a good tool for diagnosing the disease severity. Raised CRP was also associated with multiple antibiotics use and prolonged hospital stay. Increased platelet count >2.45 lacs, decreased pH, and increased PCO2 at the time of admission were associated with the requirement for increased ventilatory support in the children. The median duration of hospital stay was 8 (6) days. Conclusion: Bronchopneumonia is the predominant form of ARI in infants and toddler age group. Inflammatory markers provide valuable information regarding disease severity. Chest X-ray is important in the diagnosis of pneumonia and evaluation of the treatment response.