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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
Digital auscultation in PERCH: Associations with chest radiography and pneumonia mortality in children
Eric D McCollum1,2, Daniel E Park3,4, Nora L Watson5
1Global Program in Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Insights
Digitally recorded wheezing in children without danger signs correlated with less radiographic pneumonia and lower mortality. This suggests digital auscultation could aid child pneumonia care.
Area of Science:
- Pediatric Infectious Diseases
- Respiratory Medicine
- Digital Health Technologies
Background:
- Pneumonia remains a leading cause of child mortality in low- and middle-income countries.
- The utility of digitally recorded lung sounds for diagnosing pneumonia and predicting outcomes in these settings is not well understood.
Purpose of the Study:
- To investigate the association between digitally recorded lung sounds and radiographic pneumonia.
- To determine the relationship between lung sound characteristics and clinical outcomes, including mortality, in hospitalized children.
Main Methods:
- Enrolled 1-59 month old children hospitalized with pneumonia across eight sites in Africa and Asia.
- Collected digital stethoscope lung sound recordings, chest radiographs, and clinical outcome data.
- Classified lung sound recordings and radiographic findings, analyzing associations with pneumonia and mortality.
Main Results:
- In children without World Health Organization (WHO) danger signs, wheezing was associated with lower odds of radiographic pneumonia (aOR: 0.35) and reduced case fatality (3.8% vs. 9.1%).
- No specific lung sound classification was independently associated with radiographic pneumonia in children with WHO danger signs.
- Trends suggested higher odds of radiographic pneumonia with crackles or any wheeze in children with WHO danger signs.
Conclusions:
- Digitally recorded wheezing in lower-risk children is linked to decreased radiographic pneumonia and mortality.
- Digital auscultation shows promise as a tool to support child pneumonia management, warranting further research and development.
Background:
Whether digitally recorded lung sounds are associated with radiographic pneumonia or clinical outcomes among children in low-income and middle-income countries is unknown. We sought to address these knowledge gaps.
Methods:
We enrolled 1 to 59monthold children hospitalized with pneumonia at eight African and Asian Pneumonia Etiology Research for Child Health sites in six countries, recorded digital stethoscope lung sounds, obtained chest radiographs, and collected clinical outcomes. Recordings were processed and classified into binary categories positive or negative for adventitial lung sounds. Listening and reading panels classified recordings and radiographs. Recording classification associations with chest radiographs with World Health Organization (WHO)-defined primary endpoint pneumonia (radiographic pneumonia) or mortality were evaluated. We also examined case fatality among risk strata.
Results:
Among children without WHO danger signs, wheezing (without crackles) had a lower adjusted odds ratio (aOR) for radiographic pneumonia (0.35, 95% confidence interval (CI): 0.15, 0.82), compared to children with normal recordings. Neither crackle only (no wheeze) (aOR: 2.13, 95% CI: 0.91, 4.96) or any wheeze (with or without crackle) (aOR: 0.63, 95% CI: 0.34, 1.15) were associated with radiographic pneumonia. Among children with WHO danger signs no lung recording classification was independently associated with radiographic pneumonia, although trends toward greater odds of radiographic pneumonia were observed among children classified with crackle only (no wheeze) or any wheeze (with or without crackle). Among children without WHO danger signs, those with recorded wheezing had a lower case fatality than those without wheezing (3.8% vs. 9.1%, p = .03).
Conclusions:
Among lower risk children without WHO danger signs digitally recorded wheezing is associated with a lower odds for radiographic pneumonia and with lower mortality. Although further research is needed, these data indicate that with further development digital auscultation may eventually contribute to child pneumonia care.
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