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

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