Efficacy of Clinical and Chest Radiography Features in Predicting Patient Prognosis in Children with COVID-19

Abstract

The findings of chest radiography (chest-X ray, CXR) have not been confirmed in evaluating the prognosis of pediatric patients with coronavirus disease 2019 . In this study, we aimed to analyze the prognostic value of the CXR infiltration severity scoring system at the initial presentation of pediatric patients with COVID-19. Hospitalization and long-term data were recorded. The admission CXR data of 310 patients aged 1 month to 18 years who presented to our hospital between March 2020 and January 2021 with the diagnosis of COVID-19 confirmed by the real-time reverse transcription-polymerase chain reaction (RT-PCR) test were included in the study. The CXR images of each patient were evaluated in terms of the presence, type and localization of lesions by a radiologist, and the lung severity scores were calculated. Clinical and laboratory variables were also noted. The relationship between clinical parameters, imaging findings and patient outcomes was statistically evaluated. The median age was 9.1±5.2 years, and 59.7% of the patients (185/310) were male. Abnormal CXR findings were found in 6.5% (20/310) of the patients. CT was performed in 25 patients (8.1%), of whom 20 had normal CT findings. The time between the onset of complaints and admission to the hospital was 2.8±1.1 days in patients with abnormal CXR findings 3.0±1.4 days in those with normal findings, indicating no statistically significant difference (p=0.58). The duration of hospital stay of the patients with abnormal and normal CXR findings was 9.75±2.6 vs 9.47±2.0 days, respectively, and the difference was not statistically significant (p=0.78). None of the patients required intubation, and all had a good prognosis. For patients aged 1 month-18 years presenting to the emergency department with COVID-19, CXR presents as a useful modality in the diagnosis of associated pneumonia and it has similar results compared with CT. Our results revealed that CXR could be used in symptomatic children to assess COVID-19 pneumonia. We suggest that CT should be used for the further analysis of possible pathologic findings or complications on CXR, if clinically indicated.