Building a Prediction Model for Radiographically Confirmed Pneumonia in Peruvian Children: From Symptoms to Imaging
Farhan Pervaiz1, Miguel A Chavez2, Laura E Ellington3
1Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD.
Insights
Diagnosing childhood pneumonia in resource-poor settings is challenging. Adding lung ultrasound and auscultation to clinical assessments significantly improves diagnostic accuracy for pneumonia in children.
Area of Science:
- Pediatric infectious diseases
- Diagnostic imaging
- Global health
Background:
- Community-acquired pneumonia is a leading cause of child mortality globally.
- Current diagnostic methods in resource-limited settings lack sensitivity and specificity.
- Accurate diagnosis is crucial for effective treatment and improved child survival rates.
Purpose of the Study:
- To evaluate the diagnostic performance of clinical signs and symptoms alone versus their combination with additional tools for pneumonia in children.
- To assess the incremental value of lung auscultation, oxyhemoglobin saturation (Spo2), and lung ultrasound in diagnosing radiographically confirmed pneumonia.
- To identify optimal diagnostic strategies for pneumonia in resource-poor settings.
Main Methods:
- A cohort of children under 5 with acute respiratory illness in Lima, Peru, were enrolled.
- Logistic regression was used to assess the predictive ability of clinical data, lung auscultation, Spo2, and lung ultrasound.
- Radiographic confirmation served as the gold standard for pneumonia diagnosis.
Main Results:
- Clinical signs and symptoms alone had limited diagnostic ability (AUC=0.62).
- Adding lung auscultation improved classification (AUC=0.73), while Spo2 did not significantly enhance it (AUC=0.73).
- Lung ultrasound, specifically identifying consolidation, demonstrated the greatest improvement (AUC=0.85), with high specificity (95%).
Conclusions:
- Combining lung ultrasound and auscultation with clinical assessment significantly enhances the accurate classification of pneumonia.
- These diagnostic tools offer a promising approach to improve pneumonia diagnosis in resource-limited environments.
- Implementation of auscultation and ultrasound can increase diagnostic yield and potentially reduce child mortality from pneumonia.
Background:
Community-acquired pneumonia remains the leading cause of death in children worldwide, and current diagnostic guidelines in resource-poor settings are neither sensitive nor specific. We sought to determine the ability to correctly diagnose radiographically confirmed clinical pneumonia when diagnostics tools were added to clinical signs and symptoms in a cohort of children with acute respiratory illnesses in Peru.
Methods:
Children < 5 years of age with an acute respiratory illness presenting to a tertiary hospital in Lima, Peru, were enrolled. The ability to predict radiographically confirmed clinical pneumonia was assessed using logistic regression under four additive scenarios: clinical signs and symptoms only, addition of lung auscultation, addition of oxyhemoglobin saturation (Spo2), and addition of lung ultrasound.
Results:
Of 832 children (mean age, 21.3 months; 59% boys), 453 (54.6%) had clinical pneumonia and 221 (26.6%) were radiographically confirmed. Children with radiographically confirmed clinical pneumonia had lower average Spo2 than those without (95.9% vs 96.6%, respectively; P < .01). The ability to correctly identify radiographically confirmed clinical pneumonia using clinical signs and symptoms was limited (area under the curve [AUC] = 0.62; 95% CI, 0.58-0.67) with a sensitivity of 66% (95% CI, 59%-73%) and specificity of 53% (95% CI, 49%-57%). The addition of lung auscultation improved classification (AUC = 0.73; 95% CI, 0.69-0.77) with a sensitivity of 75% (95% CI, 69%-81%) and specificity of 53% (95% CI, 49%-57%) for the presence of crackles. In contrast, the addition of Spo2 did not improve classification (AUC = 0.73; 95% CI, 0.69-0.77) with a sensitivity of 40% (95% CI, 33%-47%) and specificity of 72% (95% CI, 68%-75%) for an Spo2 ≤ 92%. Adding consolidation on lung ultrasound was associated with the largest improvement in classification (AUC = 0.85; 95% CI, 0.82-0.89) with a sensitivity of 55% (95% CI, 48%-63%) and specificity of 95% (95% CI, 93%-97%).
Conclusions:
The addition of lung ultrasound and auscultation to clinical signs and symptoms improved the ability to correctly classify radiographically confirmed clinical pneumonia. Implementation of auscultation- and ultrasound-based diagnostic tools can be considered to improve diagnostic yield of pneumonia in resource-poor settings.
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