Purpose: Chest radiography is often performed on patients hospitalized with typical clinical manifestations of bronchiolitis. We aimed to determine the proportion of subjects with pathologic chest radiographic findings and the clinical predictors associated with pathologic chest radiographic finding...
Purpose: Chest radiography is often performed on patients hospitalized with typical clinical manifestations of bronchiolitis. We aimed to determine the proportion of subjects with pathologic chest radiographic findings and the clinical predictors associated with pathologic chest radiographic findings in young children admitted with the typical presentation of bronchiolitis. Methods: We obtained the following data at admission: sex, age, neonatal history, past history of hospitalization for respiratory illnesses, heart rate, respiratory rate, the presence of fever, total duration of fever, oxygen saturation, laboratory parameters (i.e., complete blood cell count, high-sensitivity C-reactive protein [hs-CRP], etc.), and chest radiography. Results: The study comprised 279 young children. Of these, 26 had a chest radiograph revealing opacity (n=24) or atelectasis (n=2). Multivariate logistic regression analysis showed that after adjustment for confounding factors, the clinical predictors associated with pathologic chest radiographic findings in young children admitted with bronchiolitis were elevated hs-CRP level (>0.3 mg/dL) and past history of hospitalization for respiratory illnesses (all P<0.05). Conclusion: The current study suggests that chest radiographs in young children with typical clinical manifestations of bronchiolitis have limited value. Nonetheless, young children with clinical factors such as high hs-CRP levels at admission or past history of hospitalization for respiratory illnesses may be more likely to have pathologic chest radiographic findings.
Purpose: Chest radiography is often performed on patients hospitalized with typical clinical manifestations of bronchiolitis. We aimed to determine the proportion of subjects with pathologic chest radiographic findings and the clinical predictors associated with pathologic chest radiographic findings in young children admitted with the typical presentation of bronchiolitis. Methods: We obtained the following data at admission: sex, age, neonatal history, past history of hospitalization for respiratory illnesses, heart rate, respiratory rate, the presence of fever, total duration of fever, oxygen saturation, laboratory parameters (i.e., complete blood cell count, high-sensitivity C-reactive protein [hs-CRP], etc.), and chest radiography. Results: The study comprised 279 young children. Of these, 26 had a chest radiograph revealing opacity (n=24) or atelectasis (n=2). Multivariate logistic regression analysis showed that after adjustment for confounding factors, the clinical predictors associated with pathologic chest radiographic findings in young children admitted with bronchiolitis were elevated hs-CRP level (>0.3 mg/dL) and past history of hospitalization for respiratory illnesses (all P<0.05). Conclusion: The current study suggests that chest radiographs in young children with typical clinical manifestations of bronchiolitis have limited value. Nonetheless, young children with clinical factors such as high hs-CRP levels at admission or past history of hospitalization for respiratory illnesses may be more likely to have pathologic chest radiographic findings.
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제안 방법
1). Clinical factors collected at the time of admission included sex, age, the presence or absence of fever, laboratory data, and previous hospitalization for respiratory illnesses. We reviewed chest X-rays of children with previous admission due to respiratory illnesses and confirmed that their chest X-rays normalized prior to the current illness.
Total viral RNA was obtained from nasopharyngeal aspirate specimens (300 μL) by utilizing Viral Gene-spin Viral DNA/RNA Extraction Kits (iNtRON, Seongnam, Korea) and stocked at –80℃. First-strand cDNA was manufactured by implementing Revert Aid First Strand cDNA Synthesis Kits (Fermentas Inc., Burlington, ON, Canada), followed by polymerase chain reaction (PCR) using Seeplex Respiratory Viruses Detection Kits-1 (Seegene, Seoul, Korea) and the GeneAmp PCR system 9700 (Applied Biosystems, Waltham, MA, USA). All reaction mixtures (20 μL) consisted of 3μL of cDNA, 4 μL of 5× RV1A or 5× RV1B primer, and 10 μL of 2× Multiplex Master Mix.
Multivariate logistic regression analysis was incorporated to determine clinical risk factors for pathologic chest radiographic findings; independent variables were sex (male), age under 3 months, the presence of fever, hsCRP>0.3 mg/dL, and a history of admission for respiratory illness.
We reviewed chest X-rays of children with previous admission due to respiratory illnesses and confirmed that their chest X-rays normalized prior to the current illness. On admission, all subjects underwent routine chest X-ray; blood samples were taken from subjects, and laboratory assessment such as complete blood count, absolute neutrophil count, total eosinophil count, and high-sensitivity C-reactive protein (hs-CRP) were performed. The study protocol was reviewed and approved by the Institutional Review Board of the CHA Gangnam Medical Center, CHA University, Seoul, Korea (approval number: GCI-16-23).
대상 데이터
, a constellation of clinical signs and symptoms such as a viral upper respiratory prodrome followed by increased respiratory effort and wheezing11). A total of 378 young children were admitted with bronchiolitis during the study period.
All radiographs were read at admission by physicians and at a later date by a highly experienced radiologist, who is regarded as an expert in pediatric lung diseases (HKC). A second senior staff radiologist (THK) also read the initial 279 radiographs to confirm the “expert” reading.
, (2) young children whose caregivers did not answer questionnaires on the patient’s past and parental history at the time of hospitalization, (3) young children who were born <37 weeks gestational age, or (4) young children who had a cardiac problem. Finally, 279 young children were included in the study (Fig. 1). Clinical factors collected at the time of admission included sex, age, the presence or absence of fever, laboratory data, and previous hospitalization for respiratory illnesses.
The study population consisted of 279 children. The median age of the children was 8 months.
데이터처리
P values were determined using the chi-square test.
성능/효과
After discussion by the researchers, we assessed the percentage of children with benign chest radiographic findings (i.e., bronchiolitis) and pathologic chest radiographic findings to be ≤3%±2%, with alpha=0.05 and beta=0.2, which produced a total required number of children with bronchiolitis of26018).
In conclusion, we found that chest radiographs in young children with a typical presentation of bronchiolitis have limited value; however, those with high hs-CRP levels or a history of admission due to respiratory illnesses prior to admission were approximately 1.2 times more likely to have pathologic chest radiographic findings. Further studies with larger samples sizes are needed to corroborate this finding before a clear conclusion can be drawn.
The diagnostic performance of hs-CRP levels (>0.3 mg/dL) was a sensitivity of 80.8% (95% CI, 60.7–93.5), specificity of 48.5% (95% CI, 42.5–54.6), positive predictive value of 13.0% (95% CI, 8.3–19.2), and negative predictive value of 96.4% (95% CI, 91.7–98.8) for predicting pathologic chest radiographic findings.
There were no differences between groups with regard to sex; age; birth weight, height, or head circumference; gestational age; respiratory rate, heart rate, body temperature, or oxygen saturation at admission; the presence of fever prior to admission; duration of fever prior to admission; the presence of chest retraction or wheezes; white blood cell count or total eosinophil count at admission; or virus detected. The total duration of fever (3 [0–5] days vs.
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