Chest X-ray findings of COVID-19 pneumonia in children: Experiences in a multicenter study in Thailand

• Published in: PloS one Vol. 19; no. 9; p. e0309110
• Main Authors: Kulbun, Aunya, Tovichien, Prakarn, Chaiyakulsil, Chanapai, Satdhabudha, Araya, Kamalaporn, Harutai, Sunkonkit, Kanokkarn, Uppala, Rattapon, Niyomkarn, Watit, Norasettekul, Vasinee, Ruangnapa, Kanokpan, Smathakanee, Chutima, Choursamran, Bararee, Jaroenying, Rasintra, Sriboonyong, Tidarat, Sitthikarnkha, Phanthila, Roekworachai, Koonkoaw, Ratanavongkosol, Thanyarat, Thongnual, Chutima, Deerojanawong, Jitladda
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 30-09-2024; Public Library of Science (PLoS)
• Subjects: Adolescent; Age; Blood diseases; Cardiac arrhythmia; Cardiovascular diseases; Chest; Child; Child, Preschool; Children; Classification; Comorbidity; COVID-19; COVID-19 - diagnostic imaging; COVID-19 - epidemiology; Demographics; Diseases; Dyspnea; Families & family life; Female; Genetic disorders; Humans; Infant; Infant, Newborn; Infections; Lung - diagnostic imaging; Lung diseases; Male; Medicine and Health Sciences; Obesity; Online data bases; Patients; Pediatrics; People and Places; Physical Sciences; Pneumonia; Radiography, Thoracic; Research and Analysis Methods; Respiration; Respiratory diseases; Retrospective Studies; Ribonucleic acid; Risk groups; RNA; SARS-CoV-2 - isolation & purification; Severe acute respiratory syndrome coronavirus 2; Tachypnea; Teenagers; Thailand - epidemiology; X-rays; Thailand; China
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0309110

Although chest X-ray is commonly used to diagnose COVID-19 pneumonia, few studies have explored findings in pediatric patients. This study aimed to reveal chest X-ray characteristics in children with COVID-19 pneumonia and compare between non-severe and severe cases.
This multicenter, nationwide retrospective study included all children aged 0 to 15 years who were admitted to 13 medical facilities throughout Thailand with COVID-19 pneumonia between January 2020 and October 2021. We analyzed the demographics, clinical features, and chest X-ray results of these children, and compared differences between the non-severe and severe groups.
During the study period, 1018 children (52% male, median age 5 years) were admitted with COVID-19 pneumonia. Most chest radiographic findings showed bilateral (51%) patchy/ground glass opacities (61%) in the central area (64%). Only 12% of the children exhibited typical classification for COVID-19 pneumonia, whereas 74% of chest radiographs were categorized as indeterminate. Comorbidities including chronic lung diseases [adjusted OR (95%CI): 14.56 (3.80-55.75), P-value <0.001], cardiovascular diseases [adjusted OR (95%CI): 7.54 (1.44-39.48), P-value 0.017], genetic diseases [adjusted OR (95%CI): 28.39 (4.55-177.23), P-value <0.001], clinical dyspnea [adjusted OR (95%CI): 12.13 (5.94-24.77), P-value <0.001], tachypnea [adjusted OR (95%CI): 3.92 (1.79-8.55), P-value 0.001], and bilateral chest X-ray infiltrations [adjusted OR (95%CI): 1.99 (1.05-3.78), P-value 0.036] were factors associated with severe COVID-19 pneumonia.
Most children with COVID-19 pneumonia had indeterminate chest X-rays according to the previous classification. We suggest using chest X-rays in conjunction with clinical presentation to screen high-risk patients for early detection of COVID-19 pneumonia.