| Popis: |
Background A simple objective tool to identify children with pulmonary hypertension who require prompt adenoidectomy or adenotonsillectomy is highly desirable in settings with limited echocardiography availability. Objective To determine the accuracy and feasibility of clinical-radiologic parameters for diagnosing pulmonary hypertension in children with adenoid hypertrophy. Methods Diagnostic accuracy and feasibility of clinical and lateral neck radiography parameters for echocardiography defined pulmonary hypertension were determined retrospectively in a cross-sectional study in children with clinician diagnosed adenoid hypertrophy at Kenyatta National Hospital, Kenya. Results A total of 123 children were enrolled with a median age 2.5 years [IQR 1.4 to 3.5]. History of pauses, mouth breathing, nasal obstruction or enuresis in children > 4years; palpable P2 on examination or adeno-nasopharyngeal ratio (ANR) > 0.83 had an area under the curve > 0.6 (0.61-0.65). Combinations with the highest diagnostic accuracy included mouth breathing, palpable P2, hypoxia and ANR > 0.83 (AUC 1.0); mouth breathing, palpable P2 and hypoxia (AUC 0.86) and mouth breathing and a palpable P2 (AUC 0.81); the latter being most feasible. Conclusion The diagnostic accuracy of clinical-radiological parameters for pulmonary hypertension in children with adenoid hypertrophy is modest. Combined parameters yielded increased accuracy but reduced feasibility. |
