Chest Radiographic Findings and Outcomes of Pneumonia Among Children in Botswana.

TitleChest Radiographic Findings and Outcomes of Pneumonia Among Children in Botswana.
Publication TypeJournal Article
Year of Publication2016
AuthorsKelly MS, Crotty EJ, Rattan MS, Wirth KE, Steenhoff AP, Cunningham CK, Arscott-Mills T, Boiditswe S, Chimfwembe D, David T, Finalle R, Feemster KA, Shah SS
JournalPediatr Infect Dis J
Date Published2016 Mar

BACKGROUND: Chest radiography is increasingly used to diagnose pneumonia in low-income and middle-income countries. Few studies examined whether chest radiographic findings predict outcomes of children with clinically suspected pneumonia in these settings.

METHODS: This is a hospital-based, prospective cohort study of children 1-23 months of age meeting clinical criteria for pneumonia in Botswana. Chest radiographs were reviewed by 2 pediatric radiologists to generate a consensus interpretation using standardized World Health Organization criteria. We assessed whether final chest radiograph classification was associated with our primary outcome, treatment failure at 48 hours, and secondary outcomes.

RESULTS: From April 2012 to November 2014, we enrolled 249 children with evaluable chest radiographs. Median age was 6.1 months, and 58% were male. Chest radiograph classifications were primary endpoint pneumonia (35%), other infiltrate/abnormality (42%) or no significant pathology (22%). The prevalence of endpoint consolidation was higher in children with HIV infection (P = 0.0005), whereas endpoint pleural effusions were more frequent among children with moderate or severe malnutrition (P = 0.0003). Ninety-one (37%) children failed treatment, and 12 (4.8%) children died. Primary endpoint pneumonia was associated with an increased risk of treatment failure at 48 hours (P = 0.002), a requirement for more days of respiratory support (P = 0.002) and a longer length of stay (P = 0.0003) compared with no significant pathology. Primary endpoint pneumonia also predicted a higher risk of treatment failure than other infiltrate/abnormality (P = 0.004).

CONCLUSIONS: Chest radiograph provides useful prognostic information for children meeting clinical criteria for pneumonia in Botswana. These findings highlight the potential benefit of expanded global access to diagnostic radiology services.

Alternate JournalPediatr. Infect. Dis. J.
PubMed ID26569190
PubMed Central IDPMC4752380
Grant ListP30 AI045008 / AI / NIAID NIH HHS / United States
P30 AI064518 / AI / NIAID NIH HHS / United States
T32 HD060558 / HD / NICHD NIH HHS / United States
U01 AI027535 / AI / NIAID NIH HHS / United States