Diagnostic information of clinical markers in the verification of acute infectious-inflammatory processes of the lower respiratory tract in children

Abstract

Objective. To study the clinical features of the course of community-acquired pneumonia and acute obstructive bronchitis in children of different ages in order to optimize the treatment of the acute pathology of the respiratory system.

Materials and methods. А cohort of patients with acute respiratory pathology of children with different ages (75 patients) who received inpatient treatment has been formed by the method of simple random sampling. The first (I) clinical group was formed by 51 patients with a verified diagnosis of community-acquired pneumonia, acute course, and the second (II) clinical group included 24 children, in which the infiltrative acute process in the lungs was excluded, that is, with manifestations of broncho-obstructive syndrome (BOS). According to the main clinical characteristics, the comparison groups have been comparable. The results of the study have been analyzed by parametric and non-parametric calculation methods, and the evaluation of the diagnostic value of the tests has been performed taking into account their sensitivity (Se) and specificity (Sp) from the perspective of clinical epidemiology.

Results. The analysis of the main symptoms and signs that troubled the hospitalized patients has showed that the most frequent complaints in patients with community-acquired pneumonia (CAP) were cough (100%), fever (84,3%) and signs of intoxication (90.2%), which only in every second child (45.1%) were combined with shortness of breath. At the same time, the leading combination of complaints in children with BOS were cough (100% of cases) and dyspnea (83.3% of observations), but often in combination with symptoms of intoxication (70.8% of people) and hyperthermia (in 66.7% of children). The analysis of auscultative changes above the pulmonary fields has showed the asymmetry of auscultative phenomena in majority (90.3% of children) of patients with CAP and in 16.7% of cases in the II group of (P<0,001). At the same time, the persistence of asymmetrycal auscultatory changes in the dynamics of observation for >2 days has been observed in 90.2% of cases in I group and only in 12.5% patients with BOS (P<0,001). There has been recorded the following auscultational symptoms in patients with BOS: weakened breathing diminished breath sounds above both pulmonary fields in every fifth (20.8%) patient, the presence of bilateral (without asymmetricity) crepitation/fine bubbling rales — in 12.5% of subjects. Whistling dry rales without there specific localization have been heard in all patients with BOS but in half (52.9%) patients with pneumonia (P<0.001).

Conclusion. In detecting pneumonia in children the most sensitive signs were the symptoms' complex combining cough, hyperthermia and/or intoxication, or a combination of cough with symptoms of intoxication and respiratory failure, but the most specific clinical signs were asymmetric dullness on lung percussion and combination of asymmetric diminished breath sounds with focal crepitation/fine bubbling rales which are persisting several days against the background of the initial empirical antibiotic therapy. The most significant signs of acute obstructive bronchitis in children were: the combination of normothermia with cough, wheezing, and expiratory dyspnea, and the absence of asymmetry of percussion and auscultatory phenomena along of signs of chest distention and bandbox percussion sound during examination of the chest, which, in general, are constitute sufficient grounds for patients' assigning of desobstructive therapy.