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Clinical and laboratory features of children with community-acquired pneumonia are associated with distinct radiographic presentations

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Abstract

Chest radiographs from children with community-acquired pneumonia (CAP) were categorized into three distinct presentations and each presentation was correlated to clinical and laboratory findings. Children < 59 months with CAP presenting to pediatric emergency rooms during two years were enrolled prospectively in eight centers across Europe. Clinical and laboratory data were documented and radiographs obtained from patients. Of the 1107 enrolled patients, radiographs were characterized as 74.9% alveolar CAP, 8.9% non-alveolar CAP, and 16.3% clinical CAP. Alveolar CAP patients had significantly higher rates of fever (90.7%), vomiting (27.6%), and abdominal pain (18.6%), while non-alveolar CAP patients presented more with cough (96.9%). A model using independent parameters that characterize alveolar, non-alveolar, and clinical CAP demonstrated that alveolar CAP patients were significantly older (OR = 1.02) and had significantly lower oxygen saturation than non-alveolar CAP patients (OR = 0.54). Alveolar CAP patients had significantly higher mean WBC (17,760 ± 8539.68 cells/mm3) and ANC (11.5 ± 7.5 cells/mm3) than patients categorized as non-alveolar CAP (WBC 15,160 ± 5996 cells/mm3, ANC 9.2 ± 5.1 cells/mm3) and clinical CAP (WBC 13,180 ± 5892, ANC 7.3 ± 4.7).

Conclusion: Alveolar CAP, non-alveolar CAP, and clinical CAP are distinct entities differing not only by chest radiographic appearance but also in clinical and laboratory characteristics. Alveolar CAP has unique characteristics, which suggest association with bacterial etiology.

Trial registration: Trial number 3075 (Soroka Hospital, Israel)

What is Known:

• Community-acquired pneumonia in children is diagnosed based on clinical and radiological definitions.

• Radiological criteria were standardized by WHO-SICR and have been utilized in vaccine studies.

What is New:

• Correlation between the WHO-SICR radiological definitions and clinical and laboratory parameters has not been studied.

• Using the WHO-SICR radiological definitions for alveolar community-acquired pneumonia (CAP) and non-alveolar CAP and the study definition for clinical CAP, it was found that the groups are distinct, differing clinically and in laboratory parameters.

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Abbreviations

ANC:

Absolute neutrophil count

CAP:

Community-acquired pneumonia

CAP-RI:

Community-Acquired Pneumonia Pediatric Research Initiative

CRP:

C-reactive protein

ESR:

Erythrocyte sedimentation rate

PCV:

Packed cell volume

WHO:

World Health Organization

WHO-SICR:

World Health Organization working group-WHO Standardization of Interpretation of Chest Radiographs

WBC:

White blood cells

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Author information

Authors and Affiliations

  1. Department of Pediatrics, Children’s Clinic Hospital, Faculty of Medicine, Transilvania University, Brasov, Romania

    Oana G. Falup-Pecurariu

  2. FISABIO-Public Health, (CSISP), Valencia, Spain

    Javier Diez-Domingo

  3. Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy

    Susanna Esposito

  4. Bristol Children’s Vaccine Centre, School of Clinical Sciences, University of Bristol, Bristol, UK

    Adam Finn

  5. Infectious Diseases Unit & Emergency Service, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal

    Fernanda Rodrigues

  6. First Department of Paediatrics, Agia Sophia Children’s Hospital, Athens, Greece

    Vana Spoulou

  7. Department of Paediatrics, School of Health Sciences, Faculty of Medicine, General University Hospital of Larissa, University of Thessaly, Larissa, Greece

    George A. Syrogiannopoulos

  8. Clinic of Children’s Diseases, Vilnius University, Vilnius, Lithuania

    Vytautas Usonis

  9. The Paediatric Infectious Disease Unit, Soroka University Medical Center and the Faculty of Health-Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel

    David Greenberg

Authors
  1. Oana G. Falup-Pecurariu
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  2. Javier Diez-Domingo
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  3. Susanna Esposito
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  4. Adam Finn
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  5. Fernanda Rodrigues
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  6. Vana Spoulou
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  7. George A. Syrogiannopoulos
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  8. Vytautas Usonis
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  9. David Greenberg
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Consortia

on behalf of CAP-PRI

Contributions

Oana G. Falup-Pecurariu: Collected and analyzed data, critical review of manuscript. Javier Diez-Domingo: Performed survey and analyzed data, was the main biostatistician for the study, produced the models used in the study. Susanna Esposito: Collected and analyzed data, critical review of manuscript. Adam Finn: Collected and analyzed data, critical review of manuscript. Fernanda Rodrigues: Collected and analyzed data, critical review of manuscript. Vana Spoulou: Collected and analyzed data, critical review of manuscript. George A. Syrogiannopoulos: Collected and analyzed data, critical review of manuscript. Vytautas Usonis: Collected and analyzed data, critical review of manuscript. David Greenberg: Collected and analyzed data, primary author of manuscript.

Corresponding author

Correspondence to David Greenberg.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee of the respective countries and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Additional information

Communicated by Peter de Winter

CAP-PRI Community-Acquired Pneumonia Paediatric Research Initiative is an international working group of members of ESPID, initiating and coordinating research in the area of childhood pneumonia.

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Falup-Pecurariu, O.G., Diez-Domingo, J., Esposito, S. et al. Clinical and laboratory features of children with community-acquired pneumonia are associated with distinct radiographic presentations. Eur J Pediatr 177, 1111–1120 (2018). https://doi.org/10.1007/s00431-018-3165-3

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  • DOI: https://doi.org/10.1007/s00431-018-3165-3

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