Home⇛The PCMC Journal⇛vol. 18 no. 2 (2022)

The utility of a chest radiograph in screening COVID-19 patients in a pediatric tertiary government hospital.

Janella M Tiu | Fatima I Gimenez

Discipline: medicine by specialism

 

Abstract:

Background: COVID-19 continues to be a pandemic to this time, and chest radiography has been used as a first-line triage tool due to long turnaround times of real-time reverse transcription polymerase chain reaction (RT-PCR). Chest x-ray (CXR) alone has poor sensitivity in diagnosing COVID-19, though pediatric studies on this are scarce. Objective: To evaluate the usefulness of a routine CXR as an adjunct to diagnosing suspected pediatric COVID-19. The radiographic characteristics in pediatric COVID-19 patients are also presented. Methods: A cross-sectional study involved a retrospective chart review of 259 pediatric patients admitted in a tertiary hospital with COVID-19 signs and symptoms, with baseline CXR and SARSCoV2 RT-PCR tests. Correlation of signs and symptoms with CXR findings to RT-PCR positivity was determined using univariate and multivariate logistic regression analysis. Results: The study was composed of 259 pediatric patients (ages 0-18 years old). Of these, 35 had positive findings with RT-PCR (15%). Sensitivity of a CXR with pneumonia is at 62.9%, while specificity is at 39.3%. Overall accuracy of CXR findings leading to RT-PCR positivity is 42.5%. Ground glass or hazy opacities was the most common radiographic finding (45.5%), followed by reticular opacities (31.8%). Abnormalities were mostly distributed in the inner lung zone distribution with bilateral involvement (90%). Those with difficulty of breathing were more likely to have pneumonia on their CXR, though a finding of pneumonia on CXR did not significantly correlate to a positive RT-PCR. Conclusion: Findings of pneumonia on a pediatric CXR may not necessarily lead to a positive SARS-CoV2 RT-PCR but correlating this with the patient’s clinical course and symptoms may be beneficial in effectively triaging patients at the emergency room.



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