Document Type : Original Article
Authors
1
Department of Medical Sciences, Ali-Ebne-Abitaleb School of Medicine, Islamic Azad University, Yazd, Iran
2
Children Growth Disorder Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
3
Department of Radiology, Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
4
Center for Healthcare Data Modeling, Department of Biostatistics and Epidemiology, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
5
Children Growth Disorder Research Center, Comprehensive Research Institute for Maternal and Child Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
Abstract
Background: Chest X‑ray (CXR) patterns in pediatric COVID‑19 are not well described. We aimed to characterize CXR findings in hospitalized children and to examine their associations with clinical and laboratory features.
Methods: This cross‑sectional study included all children (<18 years) with PCR‑confirmed or clinically/radiologically diagnosed COVID‑19 admitted to Shahid Sadoughi Hospital, Yazd, Iran, between February 2020 and March 2021. Admission CXRs were interpreted by a single radiologist and scored (0–18) across six lung zones. Clinical, laboratory, and outcome data were retrieved from a registry. Associations were tested with chi‑square, Mann–Whitney U, or Kruskal–Wallis tests.
Results: Among 108 children (61.1% male; mean age 5.7 ± 4.8 years), 68 (62.9%) had an abnormal CXR. The most frequent patterns were ground‑glass opacity (86.8%), peribronchial thickening (54.4%), and consolidation (45.6%). Lesions were predominantly peripheral (50.0%), bilateral (82.4%), and involved the right lower zone (52.2%). Pleural effusion (14.7%) strongly predicted mortality (risk difference 32.5%, P<0.001). Consolidation was more common with shortness of breath (68.0% vs. 20.0%, P=0.001) but less common in respiratory distress (36.7% vs. 64.7%, P=0.045). Higher CXR severity scores were associated with underlying comorbidities, hypoxia, PICU admission, and critical illness in previously healthy children (P=0.002).
Conclusion: Bilateral peripheral ground‑glass opacity and peribronchial thickening are common in pediatric COVID‑19. Consolidation, pleural effusion, and high radiographic scores correlate with severe disease and poor outcomes, supporting CXR as a useful adjunct for risk stratification in moderate‑to‑severe cases, rather than universal screening.
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