The value of radiographic findings for the progression of pandemic 2009 influenza A/H1N1 virus infection

BMC Infectious Diseases

Akihiko Saitoh¹  Hidekazu Masaki⁵  Shunsuke Nosaka⁵  Osamu Miyazaki⁵  Tomohiro Katsuta²  Nobuyuki Yotani³  Kensuke Shoji⁴  Takanori Funaki⁴ 

[1] Current address: Department of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan;Current address: Department of Pediatrics, St. Marianna University School of Medicine, Kanagawa, Japan;Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan;Department of Medical Subspecialties, Division of Infectious Diseases, National Center for Child Health and Development, Tokyo, Japan;Department of Radiology, National Center for Child Health and Development, Tokyo, Japan

关键词: Outcome;    Children;    Chest;    Influenza;   

Others  :  1145553
DOI  :  10.1186/1471-2334-13-516

 received in 2012-05-06, accepted in 2013-10-28,  发布年份 2013

【 摘 要 】

Background

Most illnesses caused by pandemic influenza A (H1N1) pdm09 virus (A/H1N1) infection are acute and self-limiting among children. However, in some children, disease progression is rapid and may require hospitalization and transfer to a pediatric intensive care unit (PICU). We investigated factors associated with rapid disease progression among children admitted to hospital for A/H1N1 infection, particularly findings on initial chest radiographs.

Methods

In this retrospective study, we investigated the records of children who had received a laboratory or clinical diagnosis of A/H1N1 infection and were admitted to the largest children’s hospital in Japan between May 2009 and March 2010. The medical records were reviewed for age, underlying diseases, vital signs on admission, initial chest radiographic findings, and clinical outcomes. According to chest radiographic findings, patients were classified into 4 groups, as follows: [1] normal (n = 46), [2] hilar and/or peribronchial markings alone (n = 64), [3] consolidation (n = 64), and [4] other findings (n = 29). Factors associated with clinical outcomes were analyzed using logistic regression.

Results

Two hundreds and three patients (median 6.8 years) were enrolled in this study. Fifteen percent (31/203) of patients were admitted to PICU. Among 31 patients, 39% (12/31) of patients required mechanical ventilation (MV). When the initial chest radiographic findings were compared between patients with consolidation (n = 64) and those without consolidation (n = 139), a higher percentage of patients with consolidation were admitted to PICU (29.7% vs.8.6%, P < 0.001) and required MV (17.2% vs. 0.7%, P < 0.001). These findings remain significant when the data were analyzed with the logistic regression (P < 0.001, P < 0.001, respectively).

Conclusions

Consolidation on initial chest radiographs was the most significant factor to predict clinical course of hospitalized children with the 2009 A/H1N1 infection.

【 授权许可】

   
2013 Funaki et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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