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Published on: December 19, 2020
Evaluating current chest imaging practices of pediatric patients with COVID-19: A retrospective analysis
Vincent R Li1, Amit Sura2, Trevor Pickering3
1Children's Hospital of Los Angeles, United States of America; University of Southern California Dornsife College of Arts and Sciences, United States of America.
Insights
Current chest imaging guidelines are effective for pediatric COVID-19 patients. Imaging like chest X-rays (CXR) and CT scans should be reserved for severely symptomatic children or those with comorbidities.
Area of Science:
- Pediatric Radiology
- Infectious Diseases
- Respiratory Medicine
Background:
- COVID-19 impacts children, necessitating clear diagnostic guidelines.
- Chest imaging plays a role in assessing pediatric respiratory illness severity.
- Current guidelines recommend judicious use of imaging in pediatric COVID-19 cases.
Purpose of the Study:
- To evaluate the adherence and effectiveness of existing chest imaging guidelines for pediatric patients with COVID-19.
- To analyze the utility of chest X-rays (CXR) and computed tomography (CT) in diagnosing COVID-19 related complications in children.
Main Methods:
- Retrospective analysis of 178 pediatric patients (0-18 years) with PCR-confirmed COVID-19.
- Review of clinical and imaging data from March to June 2020.
- Assessment of imaging findings in relation to patient symptoms and comorbidities.
Main Results:
- Only 27% (46/178) of pediatric COVID-19 patients underwent chest imaging.
- Of those imaged, 28% (13/46) showed positive findings, including pneumonia and ARDS.
- The majority of patients had significant comorbidities; imaging was often negative or showed non-COVID-19 related findings.
Conclusions:
- The study supports current guidelines for chest imaging in pediatric COVID-19.
- Chest imaging (CXR, CT) is most valuable for severely symptomatic children or those with underlying conditions.
- Reserve imaging for cases with comorbidities or when alternative diagnoses are considered.
Purpose:
This retrospective analysis aims to examine the effectiveness of the current chest imaging guidelines regarding COVID-19 positive pediatric patients on our study group of patients aged 0 to 18.
Materials And Methods:
We examined clinical and imaging data of 178 pediatric COVID-19 positive patients confirmed by PCR admitted to the Children's Hospital of Los Angeles between March 6, 2020 and June 23, 2020.
Results:
Of 178 patients, only 46 (27%) patients underwent any form of chest imaging. Thirteen (28%) of 46 imaged patients had positive chest X-rays (CXR) or computed tomography (CT) chest findings, with 8 (62%) of the 13 patients suggesting pneumonia or multifocal pneumonia, 3 (23%) patients having acute respiratory distress syndrome, and 2 (15%) patients demonstrating left sided pleural effusions thought to be the result of ruptured appendicitis unrelated to their COVID-19 diagnosis. All but one patient had significant prior medical histories with an associated comorbid medical condition. Of the 46 imaged patients, 17 (37%) patients had a negative chest X-ray, and 15 (33%) patients had suggestive findings of viral etiology. 132 patients were not imaged.
Conclusion:
Our study population corroborated current chest imaging guidelines in pediatric patients. Chest imaging modalities such as CXR and CT should be reserved for patients who are severely symptomatic and/or possess prior comorbidities such as immunosuppression, diabetes, asthma, obesity, or where other differential etiologies must be entertained.
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