Abstract
BackgroundWhether digitally recorded lung sounds are associated with radiographic pneumonia or clinical outcomes among children in low‐income and middle‐income countries is unknown. We sought to address these knowledge gaps.MethodsWe 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.ResultsAmong 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).ConclusionsAmong 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.
Highlights
According to 2017 global estimates, pneumonia is the leading infectious cause of death among children 1-59 months of age annually[1]
Recent research from the Pneumonia Etiology Research for Child Health (PERCH) study suggests that the epidemiology of lower respiratory infections among children in developing countries is shifting towards viral causes, a transition likely accelerated by the introduction of Haemophilus influenzae type b and pneumococcal conjugate vaccines in these regions[5,6]
Materials and Methods PERCH Enrollment The PERCH study prospectively enrolled hospital cases and community controls over a two year period at each site in seven countries in Africa and Asia.(5) As previously described, from December 2012 to January 2014 hospitalized children 1-59 months of age who were eligible for PERCH in Bangladesh, The Gambia, Kenya, South Africa, Thailand, and Zambia could have their lung sounds recorded during enrollment; the Mali site did not participate[14]
Summary
According to 2017 global estimates, pneumonia is the leading infectious cause of death among children 1-59 months of age annually[1]. Recent research from the Pneumonia Etiology Research for Child Health (PERCH) study suggests that the epidemiology of lower respiratory infections among children in developing countries is shifting towards viral causes, a transition likely accelerated by the introduction of Haemophilus influenzae type b and pneumococcal conjugate vaccines in these regions[5,6]. This epidemiologic transition, along with rising rates of antimicrobial resistance, have important implications for application of the WHO guidelines[7].
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