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Association of Radiology Findings with Etiology of Community Acquired Pneumonia among Children
Sandra R Arnold1, Seema Jain2, David Dansie3
1Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, TN.
Insights
Chest radiograph consolidation poorly predicts typical bacterial community-acquired pneumonia (CAP) in children, though its absence suggests a lower likelihood. Pleural effusion is a stronger indicator but is infrequent.
Area of Science:
- Pediatric Infectious Diseases
- Radiology
- Microbiology
Background:
- Community-acquired pneumonia (CAP) is a common childhood illness with diverse etiologies.
- Accurate etiological diagnosis is crucial for appropriate treatment and understanding disease burden.
- Chest radiography is frequently used to assess pneumonia severity and patterns.
Purpose of the Study:
- To investigate the association between radiographic consolidation and typical bacterial causes of childhood CAP.
- To determine the predictive value of consolidation for identifying typical bacterial CAP.
- To compare radiographic patterns across different CAP etiologies.
Main Methods:
- Retrospective analysis of hospitalized children (<18 years) with CAP.
- Chest radiographs were classified for consolidation, other infiltrates, and pleural effusion.
- Pathogen detection included bacterial and viral testing of blood and respiratory specimens.
Main Results:
- Consolidation was observed in 59% of children with CAP.
- Consolidation was most frequent in typical bacterial CAP (74%) but had low positive predictive value (12%).
- Pleural effusion was associated with typical bacterial CAP (OR 7.3) but was uncommon (13%).
Conclusions:
- Radiographic consolidation is an unreliable predictor of typical bacterial CAP in children.
- Absence of consolidation increases the likelihood that CAP is not typical bacterial.
- Pleural effusion is a significant predictor of typical bacterial CAP, despite its low prevalence.
Objective:
To evaluate the association between consolidation on chest radiograph and typical bacterial etiology of childhood community acquired pneumonia (CAP) in the Etiology of Pneumonia in the Community study.
Study Design:
Hospitalized children <18 years of age with CAP enrolled in the Etiology of Pneumonia in the Community study at 3 children's hospitals between January 2010 and June 2012 were included. Testing of blood and respiratory specimens used multiple modalities to identify typical and atypical bacterial, or viral infection. Study radiologists classified chest radiographs (consolidation, other infiltrates [interstitial and/or alveolar], pleural effusion) using modified World Health Organization pneumonia criteria. Infiltrate patterns were compared according to etiology of CAP.
Results:
Among 2212 children, there were 1302 (59%) with consolidation with or without other infiltrates, 910 (41%) with other infiltrates, and 296 (13%) with pleural effusion. In 1795 children, at least 1 pathogen was detected. Among these patients, consolidation (74%) was the most frequently observed pattern (74% in typical bacterial CAP, 58% in atypical bacterial CAP, and 54% in viral CAP). Positive and negative predictive values of consolidation for typical bacterial CAP were 12% (95% CI 10%-15%) and 96% (95% CI 95%-97%) respectively. In a multivariable model, typical bacterial CAP was associated with pleural effusion (OR 7.3, 95% CI 4.7-11.2) and white blood cell ≥15 000/mL (OR 3.2, 95% CI 2.2-4.9), and absence of wheeze (OR 0.5, 95% CI 0.3-0.8) or viral detection (OR 0.2, 95% CI 0.1-0.4).
Conclusions:
Consolidation predicted typical bacterial CAP poorly, but its absence made typical bacterial CAP unlikely. Pleural effusion was the best predictor of typical bacterial infection, but too uncommon to aid etiology prediction.
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