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Protocol and Guidelines for Point-of-Care Lung Ultrasound in Diagnosing Neonatal Pulmonary Diseases Based on International Expert Consensus
Published on: March 6, 2019
Admission chest radiographs predict illness severity for children hospitalized with pneumonia
Lauren McClain1, Matthew Hall, Samir S Shah
1Monroe Carell Jr. Children's Hospital at Vanderbilt and the Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee.
Insights
Radiographic findings in children hospitalized with pneumonia can predict outcomes. Specific patterns like multilobar infiltrates and moderate/large pleural effusions indicate a higher need for intensive care and mechanical ventilation.
Area of Science:
- Pediatric Pulmonology
- Radiology
- Critical Care Medicine
Background:
- Pneumonia is a common cause of hospitalization in children.
- Predicting disease severity and resource utilization in pediatric pneumonia is crucial for effective management.
Purpose of the Study:
- To evaluate if radiographic findings on admission chest X-rays can predict clinical outcomes in children hospitalized with pneumonia.
- To identify specific radiographic patterns associated with increased resource utilization and severe disease.
Main Methods:
- Retrospective analysis of 406 children under 18 admitted with pneumonia.
- Radiographs categorized by infiltrate patterns (lobar, multilobar, interstitial) and pleural effusion presence/size.
- Propensity scoring used to adjust for confounders like oxygen use, intensive care, and mechanical ventilation.
Main Results:
- Multilobar infiltrates and interstitial patterns were associated with higher intensive care unit (ICU) admission rates compared to single lobar infiltrates.
- Moderate to large pleural effusions significantly predicted the need for mechanical ventilation and longer hospital stays.
- Bilateral multilobar infiltrates were linked to mechanical ventilation, while any effusion increased oxygen duration.
Conclusions:
- Admission chest X-ray findings are valuable predictors of hospital outcomes in pediatric pneumonia.
- Radiographic patterns can help identify children at higher risk for severe disease and intensive interventions.
- Integrating radiographic assessment into clinical decision-making may optimize care for hospitalized children with pneumonia.
Objective:
To assess whether radiographic findings predict outcomes among children hospitalized with pneumonia.
Methods:
This retrospective study included children <18 years of age from 4 children's hospitals admitted in 2010 with clinical and radiographic evidence of pneumonia. Admission radiographs were categorized as single lobar, unilateral or bilateral multilobar, or interstitial. Pleural effusions were classified as absent, small, or moderate/large. Propensity scoring was used to adjust for potential confounders, including need for supplemental oxygen, intensive care, and mechanical ventilation, as well as hospital length of stay and duration of supplemental oxygen.
Results:
There were 406 children (median age, 3 years). Infiltrate patterns included: single lobar, 61%; multilobar unilateral, 13%; multilobar bilateral, 16%; and interstitial, 10%. Pleural effusion was present in 21%. Overall, 63% required supplemental oxygen (median duration, 31.5 hours), 8% required intensive care, and 3% required mechanical ventilation. Median length of stay was 51.5 hours. Compared with single lobar infiltrate, all other infiltrate patterns were associated with need for intensive care; only bilateral multilobar infiltrate was associated with need for mechanical ventilation (adjusted odds ratio [aOR]: 3.0, 95% confidence interval [CI]: 1.2-7.9). Presence of effusion was associated with increased length of stay and duration of supplemental oxygen; only moderate/large effusion was associated with need for intensive care (aOR: 3.2, 95% CI: 1.1-8.9) and mechanical ventilation (aOR: 14.8, 95% CI: 9.8-22.4).
Conclusions:
Admission radiographic findings are associated with important hospital outcomes and care processes and may help predict disease severity.
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