Digital auscultation in PERCH: Associations with chest radiography and pneumonia mortality in children

Eric D. McCollum, Daniel E. Park, Nora L. Watson, Nicholas S.S. Fancourt, Christopher Focht, Henry C. Baggett, W. Abdullah Brooks, Stephen R.C. Howie, Karen L. Kotloff, Orin S. Levine, Shabir A. Madhi, David R. Murdoch, J. Anthony G. Scott, Donald M. Thea, Juliet O. Awori, James Chipeta, Somchai Chuananon, Andrea N. DeLuca, Amanda Driscoll, Bernard E. EbrukeMounya Elhilali, Dimitra Emmanouilidou, Louis Peter Githua, Melissa M. Higdon, Lokman Hossain, Yasmin Jahan, Ruth A. Karron, Joshua Kyalo, David P. Moore, Justin M. Mulindwa, Sathapana Naorat, Christine Prosperi, Charl Verwey, James E. West, Maria Deloria Knoll, Katherine L. O'Brien, Daniel R. Feikin, Laura L. Hammitt

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Background: Whether digitally recorded lung sounds are associated with radiographic pneumonia or clinical outcomes among children in low-income and middle-income countries is unknown. We sought to address these knowledge gaps. Methods: We enrolled 1 to 59 month old children hospitalized with pneumonia at eight African and Asian Pneumonia Etiology Research for Child Health sites in six countries, recorded digital stethoscope lung sounds, obtained chest radiographs, and collected clinical outcomes. Recordings were processed and classified into binary categories positive or negative for adventitial lung sounds. Listening and reading panels classified recordings and radiographs. Recording classification associations with chest radiographs with World Health Organization (WHO)-defined primary endpoint pneumonia (radiographic pneumonia) or mortality were evaluated. We also examined case fatality among risk strata. Results: Among children without WHO danger signs, wheezing (without crackles) had a lower adjusted odds ratio (aOR) for radiographic pneumonia (0.35, 95% confidence interval (CI): 0.15, 0.82), compared to children with normal recordings. Neither crackle only (no wheeze) (aOR: 2.13, 95% CI: 0.91, 4.96) or any wheeze (with or without crackle) (aOR: 0.63, 95% CI: 0.34, 1.15) were associated with radiographic pneumonia. Among children with WHO danger signs no lung recording classification was independently associated with radiographic pneumonia, although trends toward greater odds of radiographic pneumonia were observed among children classified with crackle only (no wheeze) or any wheeze (with or without crackle). Among children without WHO danger signs, those with recorded wheezing had a lower case fatality than those without wheezing (3.8% vs. 9.1%, p =.03). Conclusions: Among lower risk children without WHO danger signs digitally recorded wheezing is associated with a lower odds for radiographic pneumonia and with lower mortality. Although further research is needed, these data indicate that with further development digital auscultation may eventually contribute to child pneumonia care.

Original languageEnglish (US)
Pages (from-to)3197-3208
Number of pages12
JournalPediatric pulmonology
Issue number11
StatePublished - Nov 1 2020


  • child
  • developing countries
  • digital auscultation
  • radiography
  • respiratory tract infections

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Pulmonary and Respiratory Medicine


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