What to Look for in Chest X-Rays of Pediatric Patients With COVID-19: Insights From a Colombian Cohort

Background: Despite advancements in vaccination and the transition from pandemic to endemic, SARS-CoV-2 continues to pose a medical challenge, particularly among children. In this context, imaging diagnostics, such as chest x-rays, are crucial to the initial treatment of patients. This study aims to characterize the radiological findings in pediatric patients with confirmed SARS-CoV-2 infection in Colombia between April 2020 and November 2021, as well as describe the clinical presentation, including those admission to intensive care. Methods: In Colombia, a multicenter cohort comprised patients aged 29 days to 17 years with confirmed SARS-CoV-2 infection and chest X-ray taken within 72 h of hospitalization. In two separate groups, four radiologists evaluated the images. A fifth radiologist reviewed all the X-rays; and subsequently, these readings were used to calculate the kappa coefficient and to solve discrepancies among the other radiologists. The results were compared from admission to intensive care. Results: Analysis was conducted on 392 patients with a median age of 2 years, the majority of whom (42%) were infants. Sixty-eight percent of the radiographs had normal results. Peribronchial thickening and interstitial opacity were the most common aberrant findings (59%), followed by alveolar opacity (12%). 88 percent of findings were bilateral. In our cohort, peribronchial thickening was the most common radiological pattern found in patients admitted the PICU and with ventilatory failure. Interobserver agreement was low for peribronchial thickening (kappa = 0.1), but higher for consolidations and alveolar opacities (kappa = 0.4 and 0.5, respectively). Conclusion: In pediatric patients with SARS-CoV-2, radiological findings are nonspecific and interobserver agreement is minimal. Although consolidation and alveolar opacities demonstrated greater concordance, they did not appear to reflect the clinical presentation; therefore, our results can suggest chest radiography is not considered useful for determining the severity of COVID-19 in children. There is a need for more investigations.