Chest Radiograph Findings in Childhood Pneumonia Cases From the Multisite PERCH Study

Fancourt, Nicholas; Knoll, Maria Deloria; Baggett, Henry C.; Brooks, W. Abdullah; Feikin, Daniel R.; Hammitt, Laura L.; Howie, Stephen R. C.; Kotloff, Karen L.; Levine, Orin S.; Madhi, Shabir А.; Murdoch, David R.; Scott, John A.; Thea, Donald M.; Awori, Juliet O.; Barger-Kamate, Breanna; Chipeta, James; DeLuca, Andrea N.; Diallo, Mahamadou; Driscoll, Amanda J.; Ebruke, Bernard E.; Higdon, Melissa M.; Jahan, Yasmin; Karron, Ruth A.; Mahomed, Nasreen; Moore, David P.; Nahar, Kamrun; Naorat, Sathapana; Ominde, Micah Silaba; Park, Daniel E.; Prosperi, Christine; Somwe, Somwe Wa; Thamthitiwat, Somsak; Zaman, Syed M A; Zeger, Scott L.; O’Brien, Katherine L.

doi:10.1093/cid/cix089

Cited by 60 publications

(63 citation statements)

References 20 publications

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“…By design, the WHO algorithm for the management of severe and very severe pneumonia is non-specific for pneumonia and as expected we found that a significant fraction of the children meeting these definitions do not have auscultatory findings of lower respiratory tract disease 4–7. This observation is further reflected by over a third of all PERCH cases having a normal chest radiograph 33. However, selection bias may also have influenced lung sound findings; The Gambia and South Africa sampled cases by convenience, and Thailand, Bangladesh, The Gambia and South Africa enrolled cases into the digital auscultation substudy for less than 12 months, increasing the likelihood of seasonal variation in their data.…”

Section: Discussionsupporting

confidence: 59%

“…[4][5][6][7] This observation is further reflected by over a third of all PERCH cases having a normal chest radiograph. 33 However, selection bias may also have influenced lung sound findings; The Gambia and South Africa sampled cases by convenience, and Thailand, Bangladesh, The Gambia and South Africa enrolled cases into the digital auscultation substudy for less than 12 months, increasing the likelihood of seasonal variation in their data. Our data did reveal, as expected, that cases had a markedly higher proportion of abnormal lung examinations compared with all controls.…”

Section: Discussionmentioning

confidence: 99%

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Listening panel agreement and characteristics of lung sounds digitally recorded from children aged 1–59 months enrolled in the Pneumonia Etiology Research for Child Health (PERCH) case–control study

et al. 2017

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IntroductionPaediatric lung sound recordings can be systematically assessed, but methodological feasibility and validity is unknown, especially from developing countries. We examined the performance of acoustically interpreting recorded paediatric lung sounds and compared sound characteristics between cases and controls.MethodsPneumonia Etiology Research for Child Health staff in six African and Asian sites recorded lung sounds with a digital stethoscope in cases and controls. Cases aged 1–59 months had WHO severe or very severe pneumonia; age-matched community controls did not. A listening panel assigned examination results of normal, crackle, wheeze, crackle and wheeze or uninterpretable, with adjudication of discordant interpretations. Classifications were recategorised into any crackle, any wheeze or abnormal (any crackle or wheeze) and primary listener agreement (first two listeners) was analysed among interpretable examinations using the prevalence-adjusted, bias-adjusted kappa (PABAK). We examined predictors of disagreement with logistic regression and compared case and control lung sounds with descriptive statistics.ResultsPrimary listeners considered 89.5% of 792 case and 92.4% of 301 control recordings interpretable. Among interpretable recordings, listeners agreed on the presence or absence of any abnormality in 74.9% (PABAK 0.50) of cases and 69.8% (PABAK 0.40) of controls, presence/absence of crackles in 70.6% (PABAK 0.41) of cases and 82.4% (PABAK 0.65) of controls and presence/absence of wheeze in 72.6% (PABAK 0.45) of cases and 73.8% (PABAK 0.48) of controls. Controls, tachypnoea, >3 uninterpretable chest positions, crying, upper airway noises and study site predicted listener disagreement. Among all interpretable examinations, 38.0% of cases and 84.9% of controls were normal (p<0.0001); wheezing was the most common sound (49.9%) in cases.ConclusionsListening panel and case–control data suggests our methodology is feasible, likely valid and that small airway inflammation is common in WHO pneumonia. Digital auscultation may be an important future pneumonia diagnostic in developing countries.

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Section: Discussionsupporting

confidence: 59%

Section: Discussionmentioning

confidence: 99%

Listening panel agreement and characteristics of lung sounds digitally recorded from children aged 1–59 months enrolled in the Pneumonia Etiology Research for Child Health (PERCH) case–control study

et al. 2017

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“…While study methods and case selection criteria can influence prevalence estimates of consolidation [23, 30], PERCH used a rigorously standardized study protocol and demonstrated a varied prevalence between sites [31]. Other radiographic appearances also capture cases of true pneumonia, pneumococcal or otherwise.…”

Section: Discussionmentioning

confidence: 99%

Standardized Interpretation of Chest Radiographs in Cases of Pediatric Pneumonia From the PERCH Study

Fancourt

Knoll

Barger-Kamate

et al. 2017

Clinical Infectious Diseases

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Background.Chest radiographs (CXRs) are a valuable diagnostic tool in epidemiologic studies of pneumonia. The World Health Organization (WHO) methodology for the interpretation of pediatric CXRs has not been evaluated beyond its intended application as an endpoint measure for bacterial vaccine trials.Methods.The Pneumonia Etiology Research for Child Health (PERCH) study enrolled children aged 1–59 months hospitalized with WHO-defined severe and very severe pneumonia from 7 low- and middle-income countries. An interpretation process categorized each CXR into 1 of 5 conclusions: consolidation, other infiltrate, both consolidation and other infiltrate, normal, or uninterpretable. Two members of a 14-person reading panel, who had undertaken training and standardization in CXR interpretation, interpreted each CXR. Two members of an arbitration panel provided additional independent reviews of CXRs with discordant interpretations at the primary reading, blinded to previous reports. Further discordance was resolved with consensus discussion.Results.A total of 4172 CXRs were obtained from 4232 cases. Observed agreement for detecting consolidation (with or without other infiltrate) between primary readers was 78% (κ = 0.50) and between arbitrators was 84% (κ = 0.61); agreement for primary readers and arbitrators across 5 conclusion categories was 43.5% (κ = 0.25) and 48.5% (κ = 0.32), respectively. Disagreement was most frequent between conclusions of other infiltrate and normal for both the reading panel and the arbitration panel (32% and 30% of discordant CXRs, respectively).Conclusions.Agreement was similar to that of previous evaluations using the WHO methodology for detecting consolidation, but poor for other infiltrates despite attempts at a rigorous standardization process.

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“…It is likely that symptoms of pneumonia develop over a period of several days, with nearly all sick children presenting within 14 days. In the pneumonia aetiology research for child health (PERCH) study, 44 for example, the median duration of symptoms in 967 children in seven low-income and middle-income countries with alveolar consolidation on chest radiography was 3 days (IQR: 2-6). Accordingly, for children to be defined as having pneumonia, we recommend a case definition that restricts the clinical presentation to within 2 weeks of symptom onset.…”

Section: Clinical Symptoms and Danger Signsmentioning

confidence: 99%

Challenges in the diagnosis of paediatric pneumonia in intervention field trials: recommendations from a pneumonia field trial working group

Goodman¹,

Pervaiz²,

McCollum³

et al. 2019

The Lancet Respiratory Medicine

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Pneumonia is a leading killer of children younger than 5 years despite high vaccination coverage, improved nutrition, and widespread implementation of the Integrated Management of Childhood Illnesses algorithm. Assessing the effect of interventions on childhood pneumonia is challenging because the choice of case definition and surveillance approach can affect the identification of pneumonia substantially. In anticipation of an intervention trial aimed to reduce childhood pneumonia by lowering household air pollution, we created a working group to provide recommendations regarding study design and implementation. We suggest to, first, select a standard case definition that combines acute (≤14 days) respiratory symptoms and signs and general danger signs with ancillary tests (such as chest imaging and pulse oximetry) to improve pneumonia identification; second, to prioritise active hospital-based pneumonia surveillance over passive case finding or home-based surveillance to reduce the risk of non-differential misclassification of pneumonia and, as a result, a reduced effect size in a randomised trial; and, lastly, to consider longitudinal follow-up of children younger than 1 year, as this age group has the highest incidence of severe pneumonia.

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Chest Radiograph Findings in Childhood Pneumonia Cases From the Multisite PERCH Study

Cited by 60 publications

References 20 publications

Listening panel agreement and characteristics of lung sounds digitally recorded from children aged 1–59 months enrolled in the Pneumonia Etiology Research for Child Health (PERCH) case–control study

Listening panel agreement and characteristics of lung sounds digitally recorded from children aged 1–59 months enrolled in the Pneumonia Etiology Research for Child Health (PERCH) case–control study

Standardized Interpretation of Chest Radiographs in Cases of Pediatric Pneumonia From the PERCH Study

Challenges in the diagnosis of paediatric pneumonia in intervention field trials: recommendations from a pneumonia field trial working group

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