The effectiveness of chest radiography in the diagnosis of pediatric COVID-19

Sinem Oral Cebeci 1 * , Hasret Ayyildiz Civan 2, Figen Palabıyık 3, İlyas Tolga Erkum 4, Nevin Hatipoğlu 5, Sami Hatipoğlu 4
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1 Department of Pediatric Emergency, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
2 Department of Pediatric Gastroenterology, Hepatology and Nutrition, Istanbul Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
3 Department of Pediatric Radiology, Istanbul Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
4 Department of Pediatrics, Istanbul Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
5 Department of Pediatric Infections, Istanbul Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
* Corresponding Author
J CLIN MED KAZ, Volume 18, Issue 2, pp. 20-24. https://doi.org/10.23950/jcmk/9718
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ABSTRACT

Objectives:
To determine the correlation between the PCR results and chest radiography findings of pediatric patients who were applied to pediatric emergency department with a suspicion of COVID-19 infection.

Methods:
A single-center retrospective single-blind study of patients who presented at the pediatric emergency department between 20.03.2020-15.04.2020. Patients with suspected COVID-19  infection were examined by nasopharyngeal and oropharyngeal swabs, PCR and posteroanterior (PA) chest radiographs. According to the PCR results, patients were divided into 2 groups as with (group 1) and without COVID 19 (group 2). All PA chest radiographs were evaluated by an experienced pediatric radiologist who did not know the PCR results.

Results:
167 patients were included in the study. Eighty (47.9%) of patients were female and 87 (52.1%) were male. The mean age was 8.6 ± 4.85 (1 month-16 years). The most common complaints were fever (%34.7) and cough (%54.5). 50 (32.9%) patients had a exposure history, 15 (9%) had a suspicious exposure history, and 102 (61.1%) had a history of exposure with a PCR proven COVID-19 patient. In patients with a contact to a COVID-19 patient, the most common source of infection was parents (65.7%). Out of 167 patients, 44 (26.3%) were PCR positive (group 1) and 123 (73.7%) were negative (group 2). 13 (29.5%) patients in group 1 and 14 (11.4%) patients in group 2 had findings on PA chest radiography. Among patients with signs on chest radiography (27 patients); eighteen (66.7%) patients had unilateral and 9 (33.3%) patients had bilateral lesion. In 15 (55.6%) of the cases, the finding was in single focus and in 12 (44.4%) there were multiple foci.
PA chest radiography findings were statistically significantly higher in group 1 compared to group 2 (p=0.008). There was no significant difference between the two groups in terms of bilateral lesion frequency and multi-focal presence (respectively, p=0,245, p=0,518). Unilateral lung findings were higher in group 1 compered to group 2 (p=0,023). The incidence of single focus was higher in the group 1 (20.4%) than group 2 (4.8%), (p=0,004).

Conclusion:
PA chest radiography which is widely used in all pediatric emergencies may help to diagnose COVID-19 patients with low dose radiation exposure. And this will help in rapid diagnosis and prevent unnecessary CT imaging in pediatric age group.
Keywords: Pediatric COVID-19, diagnostic imaging, imaging features, chest radiographs, coronavirus

CITATION

Oral Cebeci S, Ayyildiz Civan H, Palabıyık F, Erkum İT, Hatipoğlu N, Hatipoğlu S. The effectiveness of chest radiography in the diagnosis of pediatric COVID-19. J CLIN MED KAZ. 2021;18(2):20-4. https://doi.org/10.23950/jcmk/9718

REFERENCES

  • Guan WJ, Ni ZY, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020; 382:1708-1720. https://doi.org/10.1056/NEJMoa2002032
  • Wu C, Chen X, Cai Y, et al. Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China. JAMA Intern Med. Published online March 13, 2020. https://doi.org/10.1001/jamainternmed.2020.0994
  • Demographic Trends of COVID-19 cases and deaths in the US reported to CDC. Retrieved from https://covid.cdc.gov/covid-data-tracker/#demographics
  • Riou J, Althaus CL. Pattern of early human-to-human transmission of Wuhan 2019 novel coronavirus (2019-nCoV), December 2019 to January 2020. Euro Surveill. 2020; 25:2000058. https://doi.org/10.2807/1560-7917.ES.2020.25.4.2000058
  • Wu JT, Leung K, Leung GM. Nowcasting and forecasting the potential domestic and international spread of the 2019-nCoV outbreak originating in Wuhan, China: a modelling study. Lancet. 2020; 395:689-697. https://doi.org/10.1016/S0140-6736(20)30260-9
  • Jiang X, Rayner S, Luo MH. Does SARS-CoV-2 has a longer incubation period than SARS and MERS?. J Med Virol. 2020; 92:476‐478. https://doi.org/10.1002/jmv.25708
  • Chen ZM, Fu JF, Shu Q, et al. Diagnosis and treatment recommendations for pediatric respiratory infection caused by the 2019 novel coronavirus [published online ahead of print, 2020 Feb 5]. World J Pediatr. 2020; 1‐7. https://doi.org/10.1007/s12519-020-00345-5
  • Wang XF, Yuan J, Zheng YJ, et al. [Clinical and epidemiological characteristics of 34 children with 2019 novel coronavirus infection in Shenzhen]. Zhonghua Er Ke Za Zhi. 2020; 58:E008.
  • Chinese Society of Radiology. Radiological diagnosis of new coronavirus infected pneumonitis: Expert recommendation from the Chinese Society of Radiology (First edition). Chin J Radiol, 2020; 54: E001.
  • Zu ZY, Jiang MD, Xu PP, et al. Coronavirus Disease 2019 (COVID-19): A Perspective from China [published online ahead of print, 2020 Feb 21]. Radiology. 2020; 200490. https://doi.org/10.1148/radiol.2020200490
  • Revel MP, Parkar AP, Prosch H, et al. COVID-19 patients and the radiology department - advice from the European Society of Radiology (ESR) and the European Society of Thoracic Imaging (ESTI) [published online ahead of print, 2020 Apr 20]. Eur Radiol. 2020; 1‐7. https://doi.org/10.1007/s00330-020-06865-y
  • Wong HYF, Lam HYS, Fong AH, et al. Frequency and Distribution of Chest Radiographic Findings in COVID-19 Positive Patients [published online ahead of print, 2019 Mar 27]. Radiology. 2019; 201160.
  • Xu X, Yu C, Qu J, et al. Imaging and clinical features of patients with 2019 novel coronavirus SARS-CoV-2. Eur J Nucl Med Mol Imaging. 2020; 47:1275‐1280. https://doi.org/10.1007/s00259-020-04735-9
  • Ng MY, Lee EYP, Yang J, et al. Imaging profile of the COVID-19 infection: radiologic findings and literature review. Radiology.2020; 2: e200034 https://doi.org/10.1148/ryct.2020200034
  • Bernheim A, Mei X, Huang M, et al. Chest CT Findings in Coronavirus Disease-19 (COVID-19): Relationship to Duration of Infection. Radiology. 2020; 295:200463. https://doi.org/10.1148/radiol.2020200463
  • Lessons from the frontline of the covid-19 outbreak - The BMJ. Available at: https://blogs.bmj.com/bmj/2020/03/20/lessons-from-the-frontline-of-the-covid-19-outbreak/?utm_campaign=shareaholic&utm_medium=twitter&utm_source=socialnetwork. Accessed March 20, 2020.
  • Imaging the coronavirus disease COVID-19. Available at: http://healthcare-ineuropa.com/en/news/imaging-the-coronavirus-disease-covid-19.html. Accessed March 23, 2020.
  • CDC COVID-19 Response Team. Coronavirus Disease 2019 in Children - United States, February 12-April 2, 2020. MMWR Morb Mortal Wkly Rep. 2020; 69:422‐426. https://doi.org/10.15585/mmwr.mm6914e4
  • Wei M, Yuan J, Liu Y, et al. Novel Coronavirus Infection in Hospitalized Infants Under 1 Year of Age in China. JAMA. 2020; 323(13):1313‐1314. https://doi.org/10.1001/jama.2020.2131
  • Giacomelli A, Pezzati L, Conti F, et al. Self-reported olfactory and taste disorders in SARS-CoV-2 patients: a cross-sectional study [published online ahead of print, 2020 Mar 26]. Clin Infect Dis. 2020; ciaa330.
  • Yang W, Sirajuddin A, Zhang X, et al. The role of imaging in 2019 novel coronavirus pneumonia (COVID-19) [published online ahead of print, 2020 Apr 15]. Eur Radiol. 2020; 1‐9. https://doi.org/10.1007/s00330-020-06827-4
  • Hon KL, Leung CW, Cheng WT, et al. Clinical presentations and outcome of severe acute respiratory syndrome in children. Lancet. 2003; 361:1701‐1703. https://doi.org/10.1016/S0140-6736(03)13364-8
  • Chiu WK, Cheung PC, Ng KL, et al. Severe acute respiratory syndrome in children: experience in a regional hospital in Hong Kong. Pediatr Crit Care Med. 2003; 4:279‐283. https://doi.org/10.1097/01.PCC.0000077079.42302.81
  • Bitnun A, Allen U, Heurter H, et al. Children hospitalized with severe acute respiratory syndrome-related illness in Toronto. Pediatrics. 2003; 112:e261. https://doi.org/10.1542/peds.112.4.e261
  • Alfaraj SH, Al-Tawfiq JA, Altuwaijri TA, et al. Middle East respiratory syndrome coronavirus in pediatrics: a report of seven cases from Saudi Arabia. Front Med. 2019; 13:126‐130. https://doi.org/10.1007/s11684-017-0603-y
  • Leung CW, Kwan YW, Ko PW, et al. Severe acute respiratory syndrome among children. Pediatrics. 2004; 113:e535‐e543. https://doi.org/10.1542/peds.113.6.e535
  • Babyn PS, Chu WC, Tsou IY, et al. Severe acute respiratory syndrome (SARS): chest radiographic features in children. Pediatr Radiol. 2004; 34:47‐58. https://doi.org/10.1007/s00247-003-1081-8
  • Hosseiny M, Kooraki S, Gholamrezanezhad A, et al. Radiology Perspective of Coronavirus Disease 2019 (COVID-19): Lessons From Severe Acute Respiratory Syndrome and Middle East Respiratory Syndrome. AJR Am J Roentgenol. 2020; 214:1078‐1082. https://doi.org/10.2214/AJR.20.22969
  • Kanne JP, Little BP, Chung JH, et al. Essentials for Radiologists on COVID-19: An Update-Radiology Scientific Expert Panel [published online ahead of print, 2020 Feb 27]. Radiology. 2020; 200527.
  • Feng K, Yun YX, Wang XF, et al. [Analysis of CT features of 15 children with 2019 novel coronavirus infection]. Zhonghua Er Ke Za Zhi. 2020; 58:E007.
  • Yoon SH, Lee KH, Kim JY, et al. Chest Radiographic and CT Findings of the 2019 Novel Coronavirus Disease (COVID-19): Analysis of Nine Patients Treated in Korea. Korean J Radiol. 2020; 21:494‐500. https://doi.org/10.3348/kjr.2020.0132
  • Weinstock MB, Echenique A, Russell JW, et al. Chest x-ray findings in 636 ambulatory patients with COVID-19 presenting to an urgent care center: a normal chest x-ray is no guarantee. J Urgent Care Med. 2020; 14:13-18.
  • Shi H, Han X, Jiang N, et al. Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study. Lancet Infect Dis. 2020; 20:425‐434. https://doi.org/10.1016/S1473-3099(20)30086-4