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Respiratory morbidity in central Australian Aboriginal children with alveolar lobar abnormalities
Anne B Chang1, John P Masel, Naomi C Boyce
1Department of Respiratory Medicine, Royal Children's Hospital, Herston Road, Herston, QLD 4006, Australia. annechang@ausdoctors.net
Insights
Aboriginal children hospitalized with alveolar changes often develop chronic respiratory illness. Predischarge chest X-rays showing poor resolution predict future respiratory problems, necessitating follow-up.
Area of Science:
- Pediatric Respiratory Medicine
- Indigenous Health
- Radiology
Background:
- Alveolar lobar changes on chest radiographs are common in hospitalized Aboriginal children.
- These children often present with significant comorbidities such as anemia and otitis media.
Purpose of the Study:
- To describe short-term outcomes in Aboriginal children with radiological alveolar lobar changes.
- To determine if predischarge chest radiography can predict future respiratory morbidity.
Main Methods:
- Prospective cohort study of Aboriginal children admitted to Alice Springs Hospital.
- Chest radiographs analyzed for alveolar lobar abnormalities (> or = 1 cm consolidation).
- Follow-up conducted for 12 months, assessing comorbidities and new respiratory disease.
Main Results:
- 109 of 113 hospitalized children were Aboriginal; 124 episodes recorded.
- High rates of comorbidities (51.5% anemia, 37.3% otitis media).
- 25.6% of children developed new chronic respiratory morbidity; predischarge radiographs predicting this (RR 7.43).
Conclusions:
- Central Australian Aboriginal children face a high burden of chronic respiratory illness.
- Clinical follow-up is crucial for early detection and management.
- Predischarge chest radiographs are valuable; poor resolution indicates need for further imaging.
Objectives:
To describe the short-term outcomes in Aboriginal children admitted to hospital with radiological alveolar lobar changes; and determine whether predischarge chest radiography can predict respiratory morbidity found at follow-up. DESIGN, PARTICIPANTS, SETTING: Prospective cohort study of Aboriginal children admitted to Alice Springs Hospital between October 2000 and April 2001 with alveolar lobar abnormalities (area of consolidation, > or = 1 cm) on chest radiographs. Participants were to have a predischarge radiograph and be followed up for 12 months.
Main Outcome Measures:
Comorbidities, follow-up rate, and new respiratory disease found at follow-up.
Results:
Of 113 children hospitalised with radiological alveolar lobar changes, 109 were Aboriginal. Their median age was 1.8 years (range, 0.2 months-13.3 years), and 124 episodes were recorded. Comorbidities were common in these children (anaemia, 51.5%; suppurative otitis media, 37.3%). The follow-up rate one year after admission was 83.1% of episodes. New treatable chronic respiratory morbidity was found in 20 (25.6%) of the 78 children with completed follow-up. Predischarge chest radiographs were predictive of all chronic respiratory morbidity when they showed no or minimal resolution (0-20% resolution) (relative risk, 7.43; 95% CI, 2.07-26.60).
Conclusions:
Central Australian Aboriginal children admitted to hospital with alveolar changes on chest radiographs have a substantial burden of chronic respiratory illness, and should be clinically followed up for early detection and management of chronic respiratory morbidity. A predischarge radiograph is useful, and patients whose radiograph shows no or minimal resolution should have a follow-up x-ray film.