Digital auscultation in PERCH: Associations with chest radiography and pneumonia mortality in children.
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McCollum Eric D, Park Daniel E, Watson Nora L, Fancourt Nicholas S S, Focht Christopher, Baggett Henry C, Brooks W Abdullah, Howie Stephen R C, Kotloff Karen L, Levine Orin S, Madhi Shabir A, Murdoch David R, Scott J Anthony G, Thea Donald M, Awori Juliet O, Chipeta James, Chuananon Somchai, DeLuca Andrea N, Driscoll Amanda J, Ebruke Bernard E, Elhilali Mounya, Emmanouilidou Dimitra, Githua Louis Peter, Higdon Melissa M, Hossain Lokman, Jahan Yasmin, Karron Ruth A, Kyalo Joshua, Moore David P, Mulindwa Justin M, Naorat Sathapana, Prosperi Christine, Verwey Charl, West James E, Knoll Maria Deloria, O'Brien Katherine L, Feikin Daniel R, Hammitt Laura L
Аннотация
METHODS: We enrolled 1 to 59monthold children hospitalized with pneumonia at eight African and Asian Pneumonia Etiology Research for Child Health sites in six countries, recorded digital stethoscope lung sounds, obtained chest radiographs, and collected clinical outcomes. Recordings were processed and classified into binary categories positive or negative for adventitial lung sounds. Listening and reading panels classified recordings and radiographs. Recording classification associations with chest radiographs with World Health Organization (WHO)-defined primary endpoint pneumonia (radiographic pneumonia) or mortality were evaluated. We also examined case fatality among risk strata.
RESULTS: Among children without WHO danger signs, wheezing (without crackles) had a lower adjusted odds ratio (aOR) for radiographic pneumonia (0.35, 95% confidence interval (CI): 0.15, 0.82), compared to children with normal recordings. Neither crackle only (no wheeze) (aOR: 2.13, 95% CI: 0.91, 4.96) or any wheeze (with or without crackle) (aOR: 0.63, 95% CI: 0.34, 1.15) were associated with radiographic pneumonia. Among children with WHO danger signs no lung recording classification was independently associated with radiographic pneumonia, although trends toward greater odds of radiographic pneumonia were observed among children classified with crackle only (no wheeze) or any wheeze (with or without crackle). Among children without WHO danger signs, those with recorded wheezing had a lower case fatality than those without wheezing (3.8% vs. 9.1%, p = .03).
CONCLUSIONS: Among lower risk children without WHO danger signs digitally recorded wheezing is associated with a lower odds for radiographic pneumonia and with lower mortality. Although further research is needed, these data indicate that with further development digital auscultation may eventually contribute to child pneumonia care.