title: Chest Radiographic Findings and Outcomes of Pneumonia Among Children in Botswana.
abstract: BACKGROUND
  Chest radiography is increasingly used to diagnose pneumonia in low-income and middle-income countries. Few studies examined whether chest radiographic findings predict outcomes of children with clinically suspected pneumonia in these settings.
  
  
  METHODS
  This is a hospital-based, prospective cohort study of children 1-23 months of age meeting clinical criteria for pneumonia in Botswana. Chest radiographs were reviewed by 2 pediatric radiologists to generate a consensus interpretation using standardized World Health Organization criteria. We assessed whether final chest radiograph classification was associated with our primary outcome, treatment failure at 48 hours, and secondary outcomes.
  
  
  RESULTS
  From April 2012 to November 2014, we enrolled 249 children with evaluable chest radiographs. Median age was 6.1 months, and 58% were male. Chest radiograph classifications were primary endpoint pneumonia (35%), other infiltrate/abnormality (42%) or no significant pathology (22%). The prevalence of endpoint consolidation was higher in children with HIV infection (P = 0.0005), whereas endpoint pleural effusions were more frequent among children with moderate or severe malnutrition (P = 0.0003). Ninety-one (37%) children failed treatment, and 12 (4.8%) children died. Primary endpoint pneumonia was associated with an increased risk of treatment failure at 48 hours (P = 0.002), a requirement for more days of respiratory support (P = 0.002) and a longer length of stay (P = 0.0003) compared with no significant pathology. Primary endpoint pneumonia also predicted a higher risk of treatment failure than other infiltrate/abnormality (P = 0.004).
  
  
  CONCLUSIONS
  Chest radiograph provides useful prognostic information for children meeting clinical criteria for pneumonia in Botswana. These findings highlight the potential benefit of expanded global access to diagnostic radiology services.
authors.affiliation: From the *Botswana-UPenn Partnership, Gaborone, Botswana; †Division of Global Health, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; ‡Division of Pediatric Infectious Diseases, Duke University Medical Center, Durham, North Carolina; §Department of Radiology and Medical Imaging, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; ¶Department of Epidemiology, ‖Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; **Division of Infectious Diseases, The Children's Hospital of Philadelphia; ††Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; ‡‡Department of Pediatrics and Adolescent Health, Faculty of Medicine, University of Botswana; §§Ministry of Health, Gaborone, Botswana; and ¶¶Division of Hospital Medicine and ‖‖Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Kelly
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Crotty
authors.forename: Mantosh S
authors.initials: MS
authors.lastname: Rattan
authors.forename: Kathleen E
authors.initials: KE
authors.lastname: Wirth
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Steenhoff
authors.forename: Coleen K
authors.initials: CK
authors.lastname: Cunningham
authors.forename: Tonya
authors.initials: T
authors.lastname: Arscott-Mills
authors.forename: Sefelani
authors.initials: S
authors.lastname: Boiditswe
authors.forename: David
authors.initials: D
authors.lastname: Chimfwembe
authors.forename: Thuso
authors.initials: T
authors.lastname: David
authors.forename: Rodney
authors.initials: R
authors.lastname: Finalle
authors.forename: Kristen A
authors.initials: KA
authors.lastname: Feemster
authors.forename: Samir S
authors.initials: SS
authors.lastname: Shah
mesh_terms: D060085:Coinfection; D005260:Female; D015658:HIV Infections / Q000453:epidemiology; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D011014:Pneumonia / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000209:etiology; D013902:Radiography, Thoracic / Q000379:methods; D062606:Tertiary Care Centers