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J Prevent Med 2023, 10(1): 88-97 |
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Tarivardi M, Eskandari Neseb J, Rahmati M B, Mohammadian M, Hosseini Teshnizi S, Shahrokhi P et al . The Evaluation of Lung Computed Tomography Findings and Their Associated Factors in Children Under the Age of 18. J Prevent Med 2023; 10 (1) :88-97
URL: http://jpm.hums.ac.ir/article-1-652-en.html
URL: http://jpm.hums.ac.ir/article-1-652-en.html
Marjan Tarivardi1 
, Javad Eskandari Neseb2 , Mohammad Baqer Rahmati1 , Maryam Mohammadian1 , Saeed Hosseini Teshnizi3 , Pejman Shahrokhi4 , Mohammad Tamdandar * 5
, Javad Eskandari Neseb2 , Mohammad Baqer Rahmati1 , Maryam Mohammadian1 , Saeed Hosseini Teshnizi3 , Pejman Shahrokhi4 , Mohammad Tamdandar * 5
1- Clinical Research Development Center of Children’s Hospital, Hormozgan University of Medical Science, Bandar Abbas, Iran.
2- Student Research Committee, Faculty of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
3- Department of Medical Education, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
4- Department of Internal Medicine, Faculty of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
5- Clinical Research Development Center of Shahid Mohammadi Hospital, Hormozgan University of Medical Science, Bandar Abbas, Iran.
2- Student Research Committee, Faculty of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
3- Department of Medical Education, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
4- Department of Internal Medicine, Faculty of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
5- Clinical Research Development Center of Shahid Mohammadi Hospital, Hormozgan University of Medical Science, Bandar Abbas, Iran.
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Introduction
Coronavirus disease 2019 (COVID-19), the world’s currently common infectious disease, has been less studied in children. Reverse transcriptase-polymerase chain reaction (RT-PCR) is the standard method for the diagnosis of COVID-19; however, chest computed tomography (CT) scan can depict lung abnormalities in asymptomatic carriers even before RT-PCR is positive. The manifestations of COVID-19 in pediatric CT scans show diverse and non-specific findings. Certain pediatric patients with mild disease exhibit normal CT scans. The predominant CT scan observation in individuals with lung involvement is ground glass opacity (GGO), particularly in the peripheral and posterior areas of the lungs, along with the involvement of subpleural regions. Other manifestations, such as consolidation, GGO with consolidation, or interlobular septal thickening, may be observed in children. In certain cases, consolidation can be diffuse and is referred to as "white lung". In addition, in some instances, high-resolution CT scan alterations resemble bronchopneumonia, manifesting as patchy opacities along the bronchial vascular bundle. Pleural effusion has been documented in a significant number of children with COVID-19, whereas no instances of lymphadenopathy have been observed. Given the significance of chest CT scans and their notable sensitivity in the diagnosis of COVID-19, it is crucial to acknowledge the distinctions in CT scan observations between pediatric and adult populations. It is important to note the dearth of comprehensive investigations in Iran and globally pertaining to this subject. The objective of this study was to examine lung CT scan findings and the variables that influence these outcomes in pediatric patients diagnosed with COVID-19.
Methods
The present study employed a descriptive-analytical approach. The study sample consisted of 73 pediatric patients who were admitted to Bandar Abbas Children's Hospital between 2019 and 2020 and were diagnosed with COVID-19 using RT-PCR testing. The criteria for inclusion in the study consisted of individuals who were under the age of 18 and had tested positive for COVID-19 through the use of RT-PCR on nasopharyngeal swab specimens. The exclusion criterion were incomplete medical records. First, age and sex of the patients were extracted from their medical files. Then, their CT scans were reviewed from the picture archiving and communication system (PACS) of the hospital The CT scan images were assessed for the presence of GGO, pulmonary hilar adenopathy, pleural effusion, collapse, and peribronchial cuffing. Additionally, the side of lung involvement, whether unilateral or bilateral, was documented. The present study prioritized ethical compliance by considering the dignity and privacy of patients, as well as the preservation of medical confidentiality. Adherence to the ethical principles outlined in the Helsinki Declaration was regarded as a fundamental aspect of conducting the research, and the researcher ensured the confidentiality of information. The analysis of the data was conducted using SPSS, software, version 25. Categorical variables were described using frequency and percentage. Mean±SD were employed to describe continuous variables. The chi-square and Fisher’s exact tests were used to compare categorical variables between two groups, while the independent t-test was applied for the comparison of continuous variables.
Results
Seventy-two children with COVID-19 were evaluated in the current study. Their mean age was 4.19±3.95 years. Forty patients (53.9%) were male and 33(46.1%) were female. Lung involvement was observed in 23 patients (31.5%), of whom 6(36.1%) had right-sided and three (13%) left-sided lung involvement. Bilateral lung involvement was present in 14 patients (60.9%). The most common CT scan finding was GGO (60.9%), followed by pleural effusion (39.1%) and collapse (26.1%), while peribronchial cuffing (4.3%) was the least common CT scan finding. Moreover, none of the patients had pulmonary hilar adenopathy. There was no significant difference between children with and without lung involvement in terms of age and sex (P=0.613 and P=0.760, respectively). The percentage of girls with GGO in CT scan was significantly higher than boys with this finding (72.7% vs. 8.2%, P=0.003). Nevertheless, there was no significant difference regarding age between children with and without GGO (3.29±4.68 vs. 4.56±3.05 years, P=0.480). Moreover, children with PE were significantly older than those without PE (6.00±3.64 vs. 2.36±3.82 years, P=0.034), while there was no significant difference in sex between pediatric patients with and without pleural effusion (25% of male patients vs. 54.5% of female patients, P=0.214). In terms of other CT scan findings, including collapse and peribronchial cuffing, there were no associations with age, sex, or side of lung involvement. Also, GGO and pleural effusion were not correlated with the side of lung involvement (P=0.142 and P=0.815, respectively).
Conclusion
The findings of this study revealed 31.5% lung involvement in children with COVID-19 as observed in the chest CT scans. Among these cases, 60.9% exhibited bilateral involvement. In contrast to prior research, the current study observed a reduced proportion of children with pulmonary involvement. This discrepancy may be attributed to variations in sample size, demographic characteristics, the handling of confounding factors, and the criteria used for participant inclusion and exclusion. Conversely, research on adults consistently demonstrates a significantly greater incidence of lung involvement than children. The predominant CT scan observation in this study was GGO, aligning with the previous research on children. In the current study, while the association between the severity of observations and children's age was not evaluated, the results demonstrated a significant difference in age between children with and without pleural effusion. Hence, it is evident that lung involvement in children with COVID-19 is comparatively minimal compared to adults. Consequently, it is advisable to avoid utilizing CT scans as the sole diagnostic criterion and treatment approach for children with COVID-19, in contrast to adults. Nevertheless, previous research, particularly in the adult populations, has indicated that the prognosis and disease progression of patients can be determined by the extent of lung involvement in their initial CT scan. Therefore, while pulmonary manifestation in children is typically less pronounced compared to adults, timely identification of pulmonary involvement during the initial phases of COVID-19 can have a substantial impact on mitigating long-term pulmonary complications through the implementation of prompt therapeutic interventions.
Ethical Considerations
Compliance with ethical guidelines
The study appoved by Ethics Committee of Hormozgan University of Medical Sciences (Code: IR.HUMS.REC.1400.212). This study complies with the statements of the Declaration of Helsinki. Written informed consent was obtained from the parents/guardians of the participants.
Funding
This research did not receive any grant from funding agencies in the public, commercial, or non-profit sectors.
Authors' contributions
Conceptualization: Marjan Tariverdi; Methodology: Pejman Shahrokhi; Supervision: Mohammadbagher Rahmati; Formal analysis: Saeed Hosseini Teshnizi; Investigation: Javad Eskandari Nasab; Data curation: Maryam Mohammadian; Project administration: Javad Eskandari Nasab; Writing-original draft preparation: Mohammad Tamaddondar, Javad Eskandari Nasab, Maryam Mohammadian; Writing–review & editing: Mohammad Tamaddondar and Marjan Tariverdi.
Conflicts of interest
The authors declard no conflicts of interest.
Acknowledgements
We are sincerely thankful to our counselors in the Clinical Research Development Center of Children’s Hospital, Bandar Abbas.
References
Coronavirus disease 2019 (COVID-19), the world’s currently common infectious disease, has been less studied in children. Reverse transcriptase-polymerase chain reaction (RT-PCR) is the standard method for the diagnosis of COVID-19; however, chest computed tomography (CT) scan can depict lung abnormalities in asymptomatic carriers even before RT-PCR is positive. The manifestations of COVID-19 in pediatric CT scans show diverse and non-specific findings. Certain pediatric patients with mild disease exhibit normal CT scans. The predominant CT scan observation in individuals with lung involvement is ground glass opacity (GGO), particularly in the peripheral and posterior areas of the lungs, along with the involvement of subpleural regions. Other manifestations, such as consolidation, GGO with consolidation, or interlobular septal thickening, may be observed in children. In certain cases, consolidation can be diffuse and is referred to as "white lung". In addition, in some instances, high-resolution CT scan alterations resemble bronchopneumonia, manifesting as patchy opacities along the bronchial vascular bundle. Pleural effusion has been documented in a significant number of children with COVID-19, whereas no instances of lymphadenopathy have been observed. Given the significance of chest CT scans and their notable sensitivity in the diagnosis of COVID-19, it is crucial to acknowledge the distinctions in CT scan observations between pediatric and adult populations. It is important to note the dearth of comprehensive investigations in Iran and globally pertaining to this subject. The objective of this study was to examine lung CT scan findings and the variables that influence these outcomes in pediatric patients diagnosed with COVID-19.
Methods
The present study employed a descriptive-analytical approach. The study sample consisted of 73 pediatric patients who were admitted to Bandar Abbas Children's Hospital between 2019 and 2020 and were diagnosed with COVID-19 using RT-PCR testing. The criteria for inclusion in the study consisted of individuals who were under the age of 18 and had tested positive for COVID-19 through the use of RT-PCR on nasopharyngeal swab specimens. The exclusion criterion were incomplete medical records. First, age and sex of the patients were extracted from their medical files. Then, their CT scans were reviewed from the picture archiving and communication system (PACS) of the hospital The CT scan images were assessed for the presence of GGO, pulmonary hilar adenopathy, pleural effusion, collapse, and peribronchial cuffing. Additionally, the side of lung involvement, whether unilateral or bilateral, was documented. The present study prioritized ethical compliance by considering the dignity and privacy of patients, as well as the preservation of medical confidentiality. Adherence to the ethical principles outlined in the Helsinki Declaration was regarded as a fundamental aspect of conducting the research, and the researcher ensured the confidentiality of information. The analysis of the data was conducted using SPSS, software, version 25. Categorical variables were described using frequency and percentage. Mean±SD were employed to describe continuous variables. The chi-square and Fisher’s exact tests were used to compare categorical variables between two groups, while the independent t-test was applied for the comparison of continuous variables.
Results
Seventy-two children with COVID-19 were evaluated in the current study. Their mean age was 4.19±3.95 years. Forty patients (53.9%) were male and 33(46.1%) were female. Lung involvement was observed in 23 patients (31.5%), of whom 6(36.1%) had right-sided and three (13%) left-sided lung involvement. Bilateral lung involvement was present in 14 patients (60.9%). The most common CT scan finding was GGO (60.9%), followed by pleural effusion (39.1%) and collapse (26.1%), while peribronchial cuffing (4.3%) was the least common CT scan finding. Moreover, none of the patients had pulmonary hilar adenopathy. There was no significant difference between children with and without lung involvement in terms of age and sex (P=0.613 and P=0.760, respectively). The percentage of girls with GGO in CT scan was significantly higher than boys with this finding (72.7% vs. 8.2%, P=0.003). Nevertheless, there was no significant difference regarding age between children with and without GGO (3.29±4.68 vs. 4.56±3.05 years, P=0.480). Moreover, children with PE were significantly older than those without PE (6.00±3.64 vs. 2.36±3.82 years, P=0.034), while there was no significant difference in sex between pediatric patients with and without pleural effusion (25% of male patients vs. 54.5% of female patients, P=0.214). In terms of other CT scan findings, including collapse and peribronchial cuffing, there were no associations with age, sex, or side of lung involvement. Also, GGO and pleural effusion were not correlated with the side of lung involvement (P=0.142 and P=0.815, respectively).
Conclusion
The findings of this study revealed 31.5% lung involvement in children with COVID-19 as observed in the chest CT scans. Among these cases, 60.9% exhibited bilateral involvement. In contrast to prior research, the current study observed a reduced proportion of children with pulmonary involvement. This discrepancy may be attributed to variations in sample size, demographic characteristics, the handling of confounding factors, and the criteria used for participant inclusion and exclusion. Conversely, research on adults consistently demonstrates a significantly greater incidence of lung involvement than children. The predominant CT scan observation in this study was GGO, aligning with the previous research on children. In the current study, while the association between the severity of observations and children's age was not evaluated, the results demonstrated a significant difference in age between children with and without pleural effusion. Hence, it is evident that lung involvement in children with COVID-19 is comparatively minimal compared to adults. Consequently, it is advisable to avoid utilizing CT scans as the sole diagnostic criterion and treatment approach for children with COVID-19, in contrast to adults. Nevertheless, previous research, particularly in the adult populations, has indicated that the prognosis and disease progression of patients can be determined by the extent of lung involvement in their initial CT scan. Therefore, while pulmonary manifestation in children is typically less pronounced compared to adults, timely identification of pulmonary involvement during the initial phases of COVID-19 can have a substantial impact on mitigating long-term pulmonary complications through the implementation of prompt therapeutic interventions.
Ethical Considerations
Compliance with ethical guidelines
The study appoved by Ethics Committee of Hormozgan University of Medical Sciences (Code: IR.HUMS.REC.1400.212). This study complies with the statements of the Declaration of Helsinki. Written informed consent was obtained from the parents/guardians of the participants.
Funding
This research did not receive any grant from funding agencies in the public, commercial, or non-profit sectors.
Authors' contributions
Conceptualization: Marjan Tariverdi; Methodology: Pejman Shahrokhi; Supervision: Mohammadbagher Rahmati; Formal analysis: Saeed Hosseini Teshnizi; Investigation: Javad Eskandari Nasab; Data curation: Maryam Mohammadian; Project administration: Javad Eskandari Nasab; Writing-original draft preparation: Mohammad Tamaddondar, Javad Eskandari Nasab, Maryam Mohammadian; Writing–review & editing: Mohammad Tamaddondar and Marjan Tariverdi.
Conflicts of interest
The authors declard no conflicts of interest.
Acknowledgements
We are sincerely thankful to our counselors in the Clinical Research Development Center of Children’s Hospital, Bandar Abbas.
References
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Received: 2022/08/19 | Accepted: 2022/09/13 | Published: 2023/07/1
Received: 2022/08/19 | Accepted: 2022/09/13 | Published: 2023/07/1
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