Preliminary report from the World Health Organisation Chest Radiography in Epidemiological Studies project

Abstract

Childhood pneumonia is among the leading infectious causes of mortality in children younger than 5 years of age globally. Streptococcus pneumoniae (pneumococcus) is the leading infectious cause of childhood bacterial pneumonia. The diagnosis of childhood pneumonia remains a critical epidemiological task for monitoring vaccine and treatment program effectiveness. The chest radiograph remains the most readily available and common imaging modality to assess childhood pneumonia. In 1997, the World Health Organization Radiology Working Group was established to provide a consensus method for the standardized definition for the interpretation of pediatric frontal chest radiographs, for use in bacterial vaccine efficacy trials in children. The definition was not designed for use in individual patient clinical management because of its emphasis on specificity at the expense of sensitivity. These definitions and endpoint conclusions were published in 2001 and an analysis of observer variation for these conclusions using a reference library of chest radiographs was published in 2005. In response to the technical needs identified through subsequent meetings, the World Health Organization Chest Radiography in Epidemiological Studies (CRES) project was initiated and is designed to be a continuation of the World Health Organization Radiology Working Group. The aims of the World Health Organization CRES project are to clarify the definitions used in the World Health Organization defined standardized interpretation of pediatric chest radiographs in bacterial vaccine impact and pneumonia epidemiological studies, reinforce the focus on reproducible chest radiograph readings, provide training and support with World Health Organization defined standardized interpretation of chest radiographs and develop guidelines and tools for investigators and site staff to assist in obtaining high-quality chest radiographs.

Digital auscultation in PERCH: Associations with chest radiography and pneumonia mortality in children

“…Importantly, the WHO radiographic primary endpoint pneumonia does not differentiate between alveolar consolidation and atelectasis. 16,20 Overall the results from this analysis indicate that lung recordings have potential for use as a pneumonia diagnostic among children.…”

“…19 Furthermore, radiographic equipment is expensive, facility-based, and there is a lack of interpretation expertise in most LMICs. 20 All of these issues pose barriers to wide-scale implementation of chest radiography in LMICs. Digital stethoscopes that incorporate an automated lung sound processing algorithm, on the other hand, circumvent these obstacles and have the potential to be a community-based, noninvasive point-of-care pneumonia diagnostic.…”

Training and standardization of general practitioners in the use of lung ultrasound for the diagnosis of pediatric pneumonia

“…According to the literature, current training programs have only assessed pre‐ and posttraining knowledge, not long‐term standardization . WHO developed a methodology for CXR interpretation in the epidemiological study to allow for improved diagnosis of bacterial pediatric pneumonia and generalizability of epidemiological studies . A similar consensus methodology for LUS training and standardization may allow for better application of LUS for the diagnosis of pediatric pneumonia in low‐resource settings …”

“…12 A limitation to the use of LUS in epidemiological studies of pediatric pneumonia is a lack of consensus on what constitutes a primary endpoint pneumonia and an optimal scanning protocol 13-15 ; unlike CXR, which has well-established criteria for training and interpretation. 16 Studies have shown that LUS may be able to replace CXR as an imaging modality for pneumonia 17 with no change in clinical outcomes. 18 As the use of LUS becomes more commonplace, we are left with the challenge of disseminating this skill for further research and clinical work.…”

Imaging community-acquired pneumonia in children

“…Both clinicians and radiologists are involved in making the diagnosis of pneumonia, and these groups need clarity on their respective roles. Mahommed and colleagues [2] describe one environment where clinicians and radiologists are engaging in discussions through the World Health Organization Chest Radiography in Epidemiological Studies project and where definitions of chest radiograph findings representing pneumonia are being revised for vaccine trials. This process has come about because of criticism and dissatisfaction with the previous radiographic World Health Organization definitions for pneumonia.…”