Building a Prediction Model for Radiographically Confirmed Pneumonia in Peruvian Children: From Symptoms to Imaging.

Autor: Pervaiz F; Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD., Chavez MA; Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD; Biomedical Research Unit, A.B. PRISMA, Lima, Peru., Ellington LE; Department of Pulmonary and Sleep Medicine, Seattle Children's Hospital, University of Washington, Seattle, WA., Grigsby M; Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD., Gilman RH; Biomedical Research Unit, A.B. PRISMA, Lima, Peru; Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD., Miele CH; Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD., Figueroa-Quintanilla D; Instituto Nacional de Salud del Nino, Lima, Peru., Compen-Chang P; Instituto Nacional de Salud del Nino, Lima, Peru., Marin-Concha J; Biomedical Research Unit, A.B. PRISMA, Lima, Peru., McCollum ED; Department of Pediatrics, Eudowood Division of Pediatric Respiratory Sciences, School of Medicine Johns Hopkins University, Baltimore, MD., Checkley W; Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD; Biomedical Research Unit, A.B. PRISMA, Lima, Peru. Electronic address: wcheckl1@jhmi.edu.
Jazyk: angličtina
Zdroj: Chest [Chest] 2018 Dec; Vol. 154 (6), pp. 1385-1394. Date of Electronic Publication: 2018 Oct 03.
DOI: 10.1016/j.chest.2018.09.006
Abstrakt: 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 (Spo 2 ), 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 Spo 2 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 Spo 2 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 Spo 2  ≤ 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.
(Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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