title: The value of radiographic findings for the progression of pandemic 2009 influenza A/H1N1 virus infection.
abstract: 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.
authors.forename: Takanori
authors.initials: T
authors.lastname: Funaki
authors.forename: Kensuke
authors.initials: K
authors.lastname: Shoji
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Yotani
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Katsuta
authors.forename: Osamu
authors.initials: O
authors.lastname: Miyazaki
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Nosaka
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Masaki
authors.affiliation: Department of Medical Subspecialties, Division of Infectious Diseases, National Center for Child Health and Development, Tokyo, Japan. asaitoh@med.niigata-u.ac.jp.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Saitoh
mesh_terms: D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D053118:Influenza A Virus, H1N1 Subtype / Q000302:isolation & purification*; D007251:Influenza, Human / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000821:virology*; D015278:Intensive Care Units, Pediatric; D007564:Japan / Q000453:epidemiology; D008297:Male; D013902:Radiography, Thoracic; D012189:Retrospective Studies