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Introducing a Radiography-based Score in Children With Acute Respiratory Failure: A Cross-sectional Study
Maria Raissaki1, Stavroula Ilia2, Vasiliki Katsoula2
1Department of Radiology, University Hospital of Heraklion.
Insights
A new radiography score helps assess children with respiratory failure (RF) in the pediatric intensive care unit (PICU). This score correlates with severity, predicts outcomes, and aids in patient stratification.
Area of Science:
- Pediatric Intensive Care
- Radiology
- Respiratory Medicine
Background:
- Respiratory failure (RF) is a leading cause of pediatric intensive care unit (PICU) admissions.
- Accurate assessment of RF severity is crucial for patient management and prognosis.
Purpose of the Study:
- To develop and validate a novel radiography-based severity score for pediatric patients with RF.
- To investigate the association of this score with established clinical severity indices and patient outcomes.
Main Methods:
- A 5-point radiography score was derived using logistic regression analysis in 104 children admitted to the PICU with acute RF.
- Radiographs from PICU admission and the worst RF day were independently scored by radiologists and clinicians.
- The score was validated against Pediatric Risk of Mortality (PRISM), Pediatric Logistic Organ Dysfunction (PELOD), duration of ventilator support (DVS), and length of stay (LOS).
Main Results:
- The radiography score showed significant positive correlations with PELOD, PRISM, DVS, and LOS (all P<0.001).
- The score demonstrated significant inverse correlation with PaO2/FiO2 ratios (P<0.001).
- Scores varied significantly among diagnostic categories, with higher scores for ARDS, air-leaks, drowning, and pneumonia. Trends in scoring correlated with prolonged DVS and LOS.
Conclusions:
- A novel, simple, and structured radiography score effectively stratifies disease severity in pediatric RF.
- This score is readily usable as a bedside tool by clinicians and radiologists.
- The score demonstrates significant associations with clinical severity, mortality risk, ventilatory support duration, and hospitalization length.
Purpose:
Respiratory failure (RF) is one of the most common reasons for hospitalization in pediatric intensive care units (PICU). We propose a radiography-based severity score for the assessment of children with RF and investigate the possible associations with severity indices and outcome.
Materials And Methods:
Children with acute RF admitted in PICU were enrolled. Disease severity scores [Pediatric Risk of Mortality (PRISM) and Pediatric Logistic Organ Dysfunction (PELOD)], the ratio of partial pressure arterial oxygen and fraction of inspired oxygen (PaO2/FiO2) ratios, duration of ventilator support (DVS), length of PICU and hospital stay (LOS), and outcome were recorded. A 5-point radiography score that considered potential radiographic findings was derived through stepwise multivariable logistic regression analysis, and validated. Radiographs upon PICU admission and on the worst RF day (maximum respiratory support and worst oxygenation/ventilation parameters) were blindly reviewed and independently scored by 2 radiologists and 2 clinicians, following training.
Results:
We enrolled 104 children [median age 2.7 (interquartile range, 0.5 to 9.6) y, 65.4% boys]. Overall, 163 radiographs (PICU admission: 86, worst RF day: 77) were assessed. Radiography scores correlated positively with predicted mortality (PELOD, PRISM), DVS, LOS (all P<0.001) and inversely with PaO2/FiO2 (P<0.001). Scores differed among diagnostic categories (P<0.05); patients with acute respiratory distress syndrome, air-leaks, drowning, and pneumonia scored the highest (P<0.005). Radiography scoring trends indicating deterioration were associated with prolonged DVS, PICU, and hospital LOS (P<0.001). Agreement between all raters was good (κ=0.7, P<0.001).
Conclusions:
This novel radiography score for children with RF, associated with clinical severity scores, mortality risk, duration of ventilatory support, and hospitalization, follows a simple structured approach and can be readily utilized by radiologists and pediatricians as a bedside tool for stratification of disease severity and prognosis.
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