Digital auscultation in PERCH: Associations with chest radiography and pneumonia mortality in children.
child
developing countries
digital auscultation
radiography
respiratory tract infections
Journal
Pediatric pulmonology
ISSN: 1099-0496
Titre abrégé: Pediatr Pulmonol
Pays: United States
ID NLM: 8510590
Informations de publication
Date de publication:
11 2020
11 2020
Historique:
received:
29
04
2020
revised:
15
08
2020
accepted:
17
08
2020
pubmed:
28
8
2020
medline:
23
3
2021
entrez:
28
8
2020
Statut:
ppublish
Résumé
Whether digitally recorded lung sounds are associated with radiographic pneumonia or clinical outcomes among children in low-income and middle-income countries is unknown. We sought to address these knowledge gaps. We enrolled 1 to 59monthold children hospitalized with pneumonia at eight African and Asian Pneumonia Etiology Research for Child Health sites in six countries, recorded digital stethoscope lung sounds, obtained chest radiographs, and collected clinical outcomes. Recordings were processed and classified into binary categories positive or negative for adventitial lung sounds. Listening and reading panels classified recordings and radiographs. Recording classification associations with chest radiographs with World Health Organization (WHO)-defined primary endpoint pneumonia (radiographic pneumonia) or mortality were evaluated. We also examined case fatality among risk strata. Among children without WHO danger signs, wheezing (without crackles) had a lower adjusted odds ratio (aOR) for radiographic pneumonia (0.35, 95% confidence interval (CI): 0.15, 0.82), compared to children with normal recordings. Neither crackle only (no wheeze) (aOR: 2.13, 95% CI: 0.91, 4.96) or any wheeze (with or without crackle) (aOR: 0.63, 95% CI: 0.34, 1.15) were associated with radiographic pneumonia. Among children with WHO danger signs no lung recording classification was independently associated with radiographic pneumonia, although trends toward greater odds of radiographic pneumonia were observed among children classified with crackle only (no wheeze) or any wheeze (with or without crackle). Among children without WHO danger signs, those with recorded wheezing had a lower case fatality than those without wheezing (3.8% vs. 9.1%, p = .03). Among lower risk children without WHO danger signs digitally recorded wheezing is associated with a lower odds for radiographic pneumonia and with lower mortality. Although further research is needed, these data indicate that with further development digital auscultation may eventually contribute to child pneumonia care.
Sections du résumé
BACKGROUND
Whether digitally recorded lung sounds are associated with radiographic pneumonia or clinical outcomes among children in low-income and middle-income countries is unknown. We sought to address these knowledge gaps.
METHODS
We enrolled 1 to 59monthold children hospitalized with pneumonia at eight African and Asian Pneumonia Etiology Research for Child Health sites in six countries, recorded digital stethoscope lung sounds, obtained chest radiographs, and collected clinical outcomes. Recordings were processed and classified into binary categories positive or negative for adventitial lung sounds. Listening and reading panels classified recordings and radiographs. Recording classification associations with chest radiographs with World Health Organization (WHO)-defined primary endpoint pneumonia (radiographic pneumonia) or mortality were evaluated. We also examined case fatality among risk strata.
RESULTS
Among children without WHO danger signs, wheezing (without crackles) had a lower adjusted odds ratio (aOR) for radiographic pneumonia (0.35, 95% confidence interval (CI): 0.15, 0.82), compared to children with normal recordings. Neither crackle only (no wheeze) (aOR: 2.13, 95% CI: 0.91, 4.96) or any wheeze (with or without crackle) (aOR: 0.63, 95% CI: 0.34, 1.15) were associated with radiographic pneumonia. Among children with WHO danger signs no lung recording classification was independently associated with radiographic pneumonia, although trends toward greater odds of radiographic pneumonia were observed among children classified with crackle only (no wheeze) or any wheeze (with or without crackle). Among children without WHO danger signs, those with recorded wheezing had a lower case fatality than those without wheezing (3.8% vs. 9.1%, p = .03).
CONCLUSIONS
Among lower risk children without WHO danger signs digitally recorded wheezing is associated with a lower odds for radiographic pneumonia and with lower mortality. Although further research is needed, these data indicate that with further development digital auscultation may eventually contribute to child pneumonia care.
Identifiants
pubmed: 32852888
doi: 10.1002/ppul.25046
pmc: PMC7692889
doi:
Types de publication
Journal Article
Multicenter Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
3197-3208Subventions
Organisme : FIC NIH HHS
ID : K01 TW009988
Pays : United States
Organisme : NHLBI NIH HHS
ID : T32 HL072748
Pays : United States
Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2020 The Authors. Pediatric Pulmonology published by Wiley Periodicals LLC.
Références
PLoS One. 2012;7(1):e27793
pubmed: 22238570
Lancet Infect Dis. 2013 Dec;13(12):1057-98
pubmed: 24252483
Lancet. 2019 Aug 31;394(10200):757-779
pubmed: 31257127
PLoS One. 2010 Aug 06;5(8):e11989
pubmed: 20700510
IEEE Trans Biomed Eng. 2015 Sep;62(9):2279-88
pubmed: 25879837
Clin Infect Dis. 2017 Jun 15;64(suppl_3):S228-S237
pubmed: 28575355
Bull World Health Organ. 2005 May;83(5):353-9
pubmed: 15976876
PLoS One. 2016 Dec 28;11(12):e0168126
pubmed: 28030608
Acta Med Scand. 1984;216(1):61-6
pubmed: 6485882
BMJ Open Respir Res. 2019 Apr 15;6(1):e000393
pubmed: 31179000
Pediatr Pulmonol. 2020 Nov;55(11):3197-3208
pubmed: 32852888
Pediatr Radiol. 2017 Oct;47(11):1399-1404
pubmed: 29043423
Clin Infect Dis. 2017 Jun 15;64(suppl_3):S245-S252
pubmed: 28575358
Lancet Respir Med. 2015 Oct;3(10):755-6
pubmed: 26386598
Lancet Infect Dis. 2020 Jan;20(1):60-79
pubmed: 31678026
Am J Cardiol. 1998 Mar 1;81(5):653-6
pubmed: 9514471
Environ Res. 2017 Jul;156:358-363
pubmed: 28391175
Clin Infect Dis. 2017 Jun 15;64(suppl_3):S253-S261
pubmed: 28575359
BMJ Open Respir Res. 2017 Jun 30;4(1):e000193
pubmed: 28883927
IEEE Trans Biomed Eng. 2018 Jul;65(7):1564-1574
pubmed: 28641244
Lancet. 2018 Feb 24;391(10122):783-800
pubmed: 29273246
JAMA. 1998 Jan 28;279(4):308-13
pubmed: 9450716
PLoS One. 2017 Jan 4;12(1):e0168209
pubmed: 28052071
Clin Infect Dis. 2017 Jun 15;64(suppl_3):S262-S270
pubmed: 28575361