Clinical Outcome Prediction in Pediatric ARDS by Chest Radiograph
Severity Scoring
Abstract
Aim: To assesses the severity and prognosis of pediatric acute
respiratory distress syndrome (PARDS) based on a chest radiograph (CXR)
scoring method. Methods: 116 PARDS and 463 CXRs were selected. General
demographics, pulmonary complications, and 28‐day mortality of the
patients were recorded. Subgroup divided by prognosis (survive, death)
and etiology (infection, non-infection). CXR scores were calculated for
each of the four quadrants by infiltration extent (0-4) and density
(1-3). The ROC curve and survival curve were established, the cut-off
score for predicting prognosis was set. Results: The agreement between
two independent observers was excellent (ICC=0.98, 95%CI:0.97-0.99).
The hospital length of stay of death group was shorter than survive
group, whereas the percentage of pulmonary complication of death group
were significantly higher than survival group (all p<0.05).
Day 3 score was independently associated with better survival
(p<0.001). The aera under the curve of ROC was 0.773
(95%CI:0.709-0.838). The cut-off score was 21 (sensitivity 71.7%,
specificity 76.5%), OR was 9.268 (95%CI: 1.257-68.320). The pulmonary
complication showed an OR of 3.678 (95%CI: 1.174-11.521) for the
prediction. Conclusions: CXR score can be used in PARDS for predicting
prognosis and has a great agreement among radiologist and pediatrician.
Pulmonary complication, Day 3 score whether greater than 21 points have
a strong predictive effectiveness.