Predictive Accuracy of Chest Radiographs in Diagnosing Tachypneic Children

Seear, Michael; Awasthi, Sanjay; Gowraiah, Vishwanath; Kapoor, Rohit; Awasthi, Aradhana; Verma, Anilkumar; Al-Shabibi, Saud; Gowdy, Claire

doi:10.1007/s12098-016-2057-7

Cited by 4 publications

(3 citation statements)

References 20 publications

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“…The 2016 global EM articles selected for full review are listed in Table 4. [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] Nineteen articles were selected for inclusion, of which 15 (79%) were categorized as emergency care, three (16%) were categorized as development, and one (5%) was categorized as disaster response articles. Eighteen (95%) articles were original research manuscripts and one (5%) was a review article.…”

Section: Resultsmentioning

confidence: 99%

“…The accuracy of chest x-rays in identifying the cause of tachypnea was demonstrated to be relatively poor in India, 27 emphasizing further the need for improved diagnostic tools when assessing children in respiratory distress, especially given that pneumonia continues to account for the greatest burden of mortality in children worldwide. 35 Another diagnostic technology that has revolutionized EM in recent years and is now starting to embed itself into emergency practice worldwide, just as it has in well-resourced settings, is point-of-care ultrasound (POCUS).…”

Section: Plos Onementioning

confidence: 99%

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Global Emergency Medicine: A Review of the Literature From 2016

Becker

Hansoti

Bartels

et al. 2017

Academic Emergency Medicine

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Objectives: The Global Emergency Medicine Literature Review (GEMLR) conducts an annual search of peerreviewed and gray literature relevant to global emergency medicine (EM) to identify, review, and disseminate the most important new research in this field to a global audience of academics and clinical practitioners.Methods: This year 13,890 articles written in four languages were identified by our search. These articles were distributed among 20 reviewers for initial screening based on their relevance to the field of global EM. An additional two reviewers searched the gray literature. All articles that were deemed appropriate by at least one reviewer and approved by their editor underwent formal scoring of overall quality and importance. Two independent reviewers scored all articles.Results: A total of 716 articles met our inclusion criteria and underwent full review. Fifty-nine percent were categorized as emergency care in resource-limited settings, 17% as EM development, and 24% as disaster and humanitarian response. Nineteen articles received scores of 18.5 or higher out of a maximum score of 20 and were selected for formal summary and critique. Inter-rater reliability testing between reviewers revealed Cohen's kappa of 0.441. Conclusions:In 2016, the total number of articles identified by our search continued to increase. The proportion of articles in each of the three categories remained stable. Studies and reviews with a focus on infectious diseases, pediatrics, and the use of ultrasound in resource-limited settings represented the majority of articles selected for final review. identify and consolidate the relevant global EM literature into a format that is readily available to academics and practitioners. [1][2][3][4][5][6][7][8][9][10][11] This year, our panel of reviewers and editors included physicians from Canada, Ethiopia, Ghana, Singapore, and the United States. T he Global EmergencyOur group strives to identify the most relevant practice changing articles, by scouring both the peerreviewed and gray literature via a comprehensive search strategy. Gray literature has been defined as any material produced by an organization whose primary function is not peer-reviewed academic publication. 12Our goal in performing a gray literature search is to identify new global EM research conducted by government agencies, local or international nongovernmental organizations, or other entities that may not have published in peer-reviewed journals.The primary goals of the review are to illustrate best practices, stimulate research, and promote further professionalization in the field of global EM through the identification of important new publications that focus on emergency care in the global context, including care provision in limited-resource settings, disaster and humanitarian response, and the development of EM as a clinical discipline throughout the world. At the same time, it is important to note that this review is not a formal systematic review or meta-analysis, as it does not aim to synthesize th...

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Section: Resultsmentioning

confidence: 99%

Section: Plos Onementioning

confidence: 99%

Global Emergency Medicine: A Review of the Literature From 2016

Becker

Hansoti

Bartels

et al. 2017

Academic Emergency Medicine

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“…Similar to other studies in LMICs that used standardized WHO research methodology to interpret CXRs, our analysis revealed nearly 40% of ITIP children with CXRs and first-line intravenous antibiotic failure were without significant CXR pathology. Furthermore, most children lacking CXR pathology were low-risk since they were classified as non-severe and lacked comorbidities [17,31,32]. It is notable that having a CXR without significant pathology does not exclude pneumonia in a child with respiratory signs.…”

Section: Discussionmentioning

confidence: 99%

Chest radiography in children aged 2–59 months enrolled in the Innovative Treatments in Pneumonia (ITIP) project in Lilongwe Malawi: a secondary analysis

et al. 2022

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Background Pneumonia is the leading infectious cause of death in children aged under 5 years in low- and middle-income countries (LMICs). World Health Organization (WHO) pneumonia diagnosis guidelines rely on non-specific clinical features. We explore chest radiography (CXR) findings among select children in the Innovative Treatments in Pneumonia (ITIP) project in Malawi in relation to clinical outcomes. Methods When clinically indicated, CXRs were obtained from ITIP-enrolled children aged 2 to 59 months with community-acquired pneumonia hospitalized with treatment failure or relapse. ITIP1 (fast-breathing pneumonia) and ITIP2 (chest-indrawing pneumonia) trials enrolled children with non-severe pneumonia while ITIP3 enrolled children excluded from ITIP1 and ITIP2 with severe pneumonia and/or selected comorbidities. A panel of trained pediatricians classified the CXRs using the standardized WHO CXR research methodology. We analyzed the relationship between CXR classifications, enrollee characteristics, and outcomes. Results Between March 2016 and June 2018, of 114 CXRs obtained, 83 met analysis criteria with 62.7% (52/83) classified as having significant pathology per WHO standardized interpretation. ITIP3 (92.3%; 12/13) children had a higher proportion of CXRs with significant pathology compared to ITIP1 (57.1%, 12/21) and ITIP2 (57.1%, 28/49) (p-value = 0.008). The predominant pathological CXR reading was “other infiltrates only” in ITIP1 (83.3%, 10/12) and ITIP2 (71.4%, 20/28), while in ITIP3 it was “primary endpoint pneumonia”(66.7%, 8/12,; p-value = 0.008). The percent of CXRs with significant pathology among children clinically cured (60.6%, 40/66) vs those not clinically cured (70.6%, 12/17) at Day 14 was not significantly different (p-value = 0.58). Conclusions In this secondary analysis we observed that ITIP3 children with severe pneumonia and/or selected comorbidities had a higher frequency of CXRs with significant pathology, although these radiographic findings had limited relationship to Day 14 outcomes. The proportion of CXRs with “primary endpoint pneumonia” was low. These findings add to existing data that additional diagnostics and prognostics are important for improving the care of children with pneumonia in LMICs. Trial registration ITIP1, ITIP2, and ITIP3 were registered with ClinicalTrials.gov (NCT02760420, NCT02678195, and NCT02960919, respectively).

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