A Clinico-Radiological Correlation Study in Children With Severe Community-Acquired Pneumonia: Does This Child Have Pneumonia?

Background: Pneumonia remains a leading cause of morbidity and mortality among children under five years of age, particularly in developing countries. Although the World Health Organization (WHO) provides clinical criteria for diagnosing severe pneumonia, overlapping features with other respiratory illnesses may limit diagnostic accuracy. Radiological evaluation, especially chest radiography, plays a crucial role in confirming diagnosis, assessing severity, and identifying complications. Materials and methods: This analytical cross-sectional study included 300 consecutively enrolled children aged 2-60 months admitted with WHO-defined severe community-acquired pneumonia. Clinical data, including demographic characteristics, presenting symptoms, and physical signs, were systematically recorded. Oxygen saturation was measured using pulse oximetry. Laboratory parameters, including complete blood counts and erythrocyte sedimentation rate, were analyzed. Chest radiographs were performed in all patients and categorized into pneumonic consolidation, interstitial pneumonia, bronchopneumonia, and associated complications. Radiographs were independently interpreted to reduce observer bias. For statistical analysis, radiological findings were categorized as a binary variable (presence or absence of any abnormality on chest X-ray), and associations between clinical parameters and radiological abnormalities were assessed using the chi-square test. Results: The majority of patients (228, 76%) were aged 2-12 months, with a male predominance of 204 (68%). Common presenting features included cough in 295 (98.4%), hurried breathing in 300 (100%), and fever in 240 (80%), while lethargy was noted in 134 (44.8%) of cases. Clinical examination revealed tachypnea in 293 (97.6%), chest retractions in 288 (96%), crepitations in 192 (64%), wheezing in 96 (32%), and bronchial breath sounds in 84 (28%) of patients. Hypoxemia (SpO₂ <90%) was present in 192 (64%) of cases. Laboratory findings demonstrated leukocytosis in 156 (52%), neutrophilia in 168 (56%), anemia in 146 (48.8%), and elevated ESR in 185 (61.6%) of patients. Radiological abnormalities were identified in 156 (52%) of cases, with pneumonic consolidation in 138 (46%) being the most common pattern, followed by interstitial pneumonia in 102 (34%) and bronchopneumonia in 45 (15%). Complications such as pleural effusion and empyema were infrequent. A statistically significant association was observed between clinical parameters and the presence of radiological abnormalities on chest X-ray, including fever (p<0.001), hypoxemia (p<0.001), cyanosis (p=0.0097), wheezing (p=0.014), palpitations (p<0.001), and bronchial breath sounds (p<0.001). Conclusion: Clinical features, particularly hypoxemia, bronchial breath sounds, and palpitations, show a strong association with the presence of radiological abnormalities in pediatric pneumonia. Chest radiography remains an essential tool for confirming diagnosis, characterizing disease patterns, and detecting complications. A combined clinical and radiological approach enhances diagnostic accuracy and supports effective management in children with severe community-acquired pneumonia.