Identification of Radiological Alveolar Pneumonia in Children With High Rates of Hospitalized Respiratory Infections

Comparison of WHO-Defined and Pediatric Pulmonologist Diagnosis in the Clinical Context

Kerry-Ann O'Grady, Paul Torzillo, Alan Ruben, Debbie Taylor-Thomson, Patricia Valery, Anne Chang

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: A reliable standardized diagnosis of pneumonia in children has long been difficult to achieve. Clinical and radiological criteria have been developed by the World Health Organization (WHO), however, their generalizability to different populations is uncertain. We evaluated WHO defined chest radiograph (CXRs) confirmed alveolar pneumonia in the clinical context in Central Australian Aboriginal children, a high risk population, hospitalized with acute lower respiratory illness (ALRI).

Methods:
CXRs in children (aged 1-60 months) hospitalized and treated with intravenous antibiotics for ALRI and enrolled in a randomized controlled trial (RCT) of Vitamin A/Zinc supplementation were matched with data collected during a population-based study of WHO-defined primary endpoint pneumonia (WHO-EPC). These CXRs were reread by a pediatric pulmonologist (PP) and classified as pneumonia-PP when alveolar changes were present. Sensitivities, specificities, positive and negative predictive values (PPV, NPV) for clinical presentations were compared between WHO-EPC and pneumonia-PP.

Results: Of the 147 episodes of hospitalized ALRI, WHO-EPC was significantly less commonly diagnosed in 40 (27.2%) compared to pneumonia-PP (difference 20.4%, 95% CI 9.6-31.2, P < 0.001). Clinical signs on admission were poor predictors for both pneumonia-PP and WHO-EPC; the sensitivities of clinical signs ranged from a high of 45% for tachypnea to 5% for fever + tachypnea + chest-indrawing. The PPV range was 40-20%, respectively. Higher PPVs were observed against the pediatric pulmonologist's diagnosis compared to WHO-EPC.

Conclusions:
WHO-EPC underestimates alveolar consolidation in a clinical context. Its use in clinical practice or in research designed to inform clinical management in this population should be avoided. Pediatr Pulmonol. 2012; 47:386-392.
Original languageEnglish
Pages (from-to)386-392
Number of pages7
JournalPediatric Pulmonology
Volume47
Issue number4
DOIs
Publication statusPublished - 2011

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Respiratory Tract Infections
Pneumonia
Pediatrics
Tachypnea
Population
Thorax
Pulmonologists
Vitamin A
erucylphosphocholine
Zinc
Fever
Randomized Controlled Trials
Anti-Bacterial Agents
Sensitivity and Specificity
Research

Cite this

@article{8525e8fb8d504ec1b7658ef398ee10c4,
title = "Identification of Radiological Alveolar Pneumonia in Children With High Rates of Hospitalized Respiratory Infections: Comparison of WHO-Defined and Pediatric Pulmonologist Diagnosis in the Clinical Context",
abstract = "Background: A reliable standardized diagnosis of pneumonia in children has long been difficult to achieve. Clinical and radiological criteria have been developed by the World Health Organization (WHO), however, their generalizability to different populations is uncertain. We evaluated WHO defined chest radiograph (CXRs) confirmed alveolar pneumonia in the clinical context in Central Australian Aboriginal children, a high risk population, hospitalized with acute lower respiratory illness (ALRI). Methods: CXRs in children (aged 1-60 months) hospitalized and treated with intravenous antibiotics for ALRI and enrolled in a randomized controlled trial (RCT) of Vitamin A/Zinc supplementation were matched with data collected during a population-based study of WHO-defined primary endpoint pneumonia (WHO-EPC). These CXRs were reread by a pediatric pulmonologist (PP) and classified as pneumonia-PP when alveolar changes were present. Sensitivities, specificities, positive and negative predictive values (PPV, NPV) for clinical presentations were compared between WHO-EPC and pneumonia-PP. Results: Of the 147 episodes of hospitalized ALRI, WHO-EPC was significantly less commonly diagnosed in 40 (27.2{\%}) compared to pneumonia-PP (difference 20.4{\%}, 95{\%} CI 9.6-31.2, P < 0.001). Clinical signs on admission were poor predictors for both pneumonia-PP and WHO-EPC; the sensitivities of clinical signs ranged from a high of 45{\%} for tachypnea to 5{\%} for fever + tachypnea + chest-indrawing. The PPV range was 40-20{\%}, respectively. Higher PPVs were observed against the pediatric pulmonologist's diagnosis compared to WHO-EPC. Conclusions: WHO-EPC underestimates alveolar consolidation in a clinical context. Its use in clinical practice or in research designed to inform clinical management in this population should be avoided. Pediatr Pulmonol. 2012; 47:386-392.",
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author = "Kerry-Ann O'Grady and Paul Torzillo and Alan Ruben and Debbie Taylor-Thomson and Patricia Valery and Anne Chang",
year = "2011",
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pages = "386--392",
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Identification of Radiological Alveolar Pneumonia in Children With High Rates of Hospitalized Respiratory Infections : Comparison of WHO-Defined and Pediatric Pulmonologist Diagnosis in the Clinical Context. / O'Grady, Kerry-Ann; Torzillo, Paul; Ruben, Alan; Taylor-Thomson, Debbie; Valery, Patricia ; Chang, Anne.

In: Pediatric Pulmonology, Vol. 47, No. 4, 2011, p. 386-392.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Identification of Radiological Alveolar Pneumonia in Children With High Rates of Hospitalized Respiratory Infections

T2 - Comparison of WHO-Defined and Pediatric Pulmonologist Diagnosis in the Clinical Context

AU - O'Grady, Kerry-Ann

AU - Torzillo, Paul

AU - Ruben, Alan

AU - Taylor-Thomson, Debbie

AU - Valery, Patricia

AU - Chang, Anne

PY - 2011

Y1 - 2011

N2 - Background: A reliable standardized diagnosis of pneumonia in children has long been difficult to achieve. Clinical and radiological criteria have been developed by the World Health Organization (WHO), however, their generalizability to different populations is uncertain. We evaluated WHO defined chest radiograph (CXRs) confirmed alveolar pneumonia in the clinical context in Central Australian Aboriginal children, a high risk population, hospitalized with acute lower respiratory illness (ALRI). Methods: CXRs in children (aged 1-60 months) hospitalized and treated with intravenous antibiotics for ALRI and enrolled in a randomized controlled trial (RCT) of Vitamin A/Zinc supplementation were matched with data collected during a population-based study of WHO-defined primary endpoint pneumonia (WHO-EPC). These CXRs were reread by a pediatric pulmonologist (PP) and classified as pneumonia-PP when alveolar changes were present. Sensitivities, specificities, positive and negative predictive values (PPV, NPV) for clinical presentations were compared between WHO-EPC and pneumonia-PP. Results: Of the 147 episodes of hospitalized ALRI, WHO-EPC was significantly less commonly diagnosed in 40 (27.2%) compared to pneumonia-PP (difference 20.4%, 95% CI 9.6-31.2, P < 0.001). Clinical signs on admission were poor predictors for both pneumonia-PP and WHO-EPC; the sensitivities of clinical signs ranged from a high of 45% for tachypnea to 5% for fever + tachypnea + chest-indrawing. The PPV range was 40-20%, respectively. Higher PPVs were observed against the pediatric pulmonologist's diagnosis compared to WHO-EPC. Conclusions: WHO-EPC underestimates alveolar consolidation in a clinical context. Its use in clinical practice or in research designed to inform clinical management in this population should be avoided. Pediatr Pulmonol. 2012; 47:386-392.

AB - Background: A reliable standardized diagnosis of pneumonia in children has long been difficult to achieve. Clinical and radiological criteria have been developed by the World Health Organization (WHO), however, their generalizability to different populations is uncertain. We evaluated WHO defined chest radiograph (CXRs) confirmed alveolar pneumonia in the clinical context in Central Australian Aboriginal children, a high risk population, hospitalized with acute lower respiratory illness (ALRI). Methods: CXRs in children (aged 1-60 months) hospitalized and treated with intravenous antibiotics for ALRI and enrolled in a randomized controlled trial (RCT) of Vitamin A/Zinc supplementation were matched with data collected during a population-based study of WHO-defined primary endpoint pneumonia (WHO-EPC). These CXRs were reread by a pediatric pulmonologist (PP) and classified as pneumonia-PP when alveolar changes were present. Sensitivities, specificities, positive and negative predictive values (PPV, NPV) for clinical presentations were compared between WHO-EPC and pneumonia-PP. Results: Of the 147 episodes of hospitalized ALRI, WHO-EPC was significantly less commonly diagnosed in 40 (27.2%) compared to pneumonia-PP (difference 20.4%, 95% CI 9.6-31.2, P < 0.001). Clinical signs on admission were poor predictors for both pneumonia-PP and WHO-EPC; the sensitivities of clinical signs ranged from a high of 45% for tachypnea to 5% for fever + tachypnea + chest-indrawing. The PPV range was 40-20%, respectively. Higher PPVs were observed against the pediatric pulmonologist's diagnosis compared to WHO-EPC. Conclusions: WHO-EPC underestimates alveolar consolidation in a clinical context. Its use in clinical practice or in research designed to inform clinical management in this population should be avoided. Pediatr Pulmonol. 2012; 47:386-392.

KW - antibiotic agent

KW - penicillin G

KW - retinol

KW - zinc

KW - alveolar bone

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KW - infant

KW - lower respiratory tract infection

KW - major clinical study

KW - male

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KW - tachypnea

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KW - Australia

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KW - Dietary Supplements

KW - Female

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KW - Oceanic Ancestry Group

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KW - Randomized Controlled Trials as Topic

KW - Respiratory Tract Infections

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KW - World Health Organization

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JO - Pediatric Pulmonology

JF - Pediatric Pulmonology

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