{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T23:34:51Z","timestamp":1790379291479,"version":"4.1.0"},"reference-count":26,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2020,9,11]],"date-time":"2020-09-11T00:00:00Z","timestamp":1599782400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Pulmonology"],"published-print":{"date-parts":[[2020,11]]},"abstract":"Abstract<\/jats:title>Background<\/jats:title>Whether digitally recorded lung sounds are associated with radiographic pneumonia or clinical outcomes among children in low\u2010income and middle\u2010income countries is unknown. We sought to address these knowledge gaps.<\/jats:p><\/jats:sec>Methods<\/jats:title>We enrolled 1 to 59monthold 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)\u2010defined primary endpoint pneumonia (radiographic pneumonia) or mortality were evaluated. We also examined case fatality among risk strata.<\/jats:p><\/jats:sec>Results<\/jats:title>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<\/jats:italic>\u2009=\u2009.03).<\/jats:p><\/jats:sec>Conclusions<\/jats:title>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.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ppul.25046","type":"journal-article","created":{"date-parts":[[2020,8,27]],"date-time":"2020-08-27T16:54:48Z","timestamp":1598547288000},"page":"3197-3208","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Digital auscultation in PERCH: Associations with chest radiography and pneumonia mortality in children"],"prefix":"10.1002","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1872-5566","authenticated-orcid":false,"given":"Eric D.","family":"McCollum","sequence":"first","affiliation":[{"name":"Global Program in Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences Johns Hopkins School of Medicine Baltimore Maryland USA"},{"name":"Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5139-5397","authenticated-orcid":false,"given":"Daniel E.","family":"Park","sequence":"additional","affiliation":[{"name":"Department of International Health, International Vaccine Access Center Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA"},{"name":"Department of Epidemiology and Biostatistics, Milken Institute School of Public Health George Washington University Washington District of Columbia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nora L.","family":"Watson","sequence":"additional","affiliation":[{"name":"The Emmes Corporation Rockville Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1772-9960","authenticated-orcid":false,"given":"Nicholas S. S.","family":"Fancourt","sequence":"additional","affiliation":[{"name":"Department of International Health, International Vaccine Access Center Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Focht","sequence":"additional","affiliation":[{"name":"The Emmes Corporation Rockville Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henry C.","family":"Baggett","sequence":"additional","affiliation":[{"name":"Global Disease Detection Center, US Centers for Disease Control and Prevention Collaboration Thailand Ministry of Public Health Mueang Nonthaburi Nonthaburi Thailand"},{"name":"Division of Global Health Protection, Center for Global Health Centers for Disease Control and Prevention Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W. Abdullah","family":"Brooks","sequence":"additional","affiliation":[{"name":"Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA"},{"name":"International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) Dhaka and Matlab Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen R. C.","family":"Howie","sequence":"additional","affiliation":[{"name":"Medical Research Council Unit Basse The Gambia"},{"name":"Department of Paediatrics University of Auckland Auckland New Zealand"},{"name":"Centre for International Health University of Otago Dunedin New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen L.","family":"Kotloff","sequence":"additional","affiliation":[{"name":"Division of Infectious Disease and Tropical Pediatrics, Department of Pediatrics, Center for Vaccine Development and Global Health University of Maryland School of Medicine Baltimore Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Orin S.","family":"Levine","sequence":"additional","affiliation":[{"name":"Department of International Health, International Vaccine Access Center Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA"},{"name":"Bill & Melinda Gates Foundation Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shabir A.","family":"Madhi","sequence":"additional","affiliation":[{"name":"Medical Research Council: Respiratory and Meningeal Pathogens Research Unit University of the Witwatersrand Johannesburg South Africa"},{"name":"Department of Science and Technology\/National Research Foundation: Vaccine Preventable Diseases Unite University of the Witwatersrand Johannesburg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David R.","family":"Murdoch","sequence":"additional","affiliation":[{"name":"Department of Pathology and Biomedical Science University of Otago Christchurch New Zealand"},{"name":"Microbiology Unit Canterbury Health Laboratories Christchurch New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. Anthony G.","family":"Scott","sequence":"additional","affiliation":[{"name":"Kenya Medical Research Institute\u2010Wellcome Trust Research Programme Kilifi Kenya"},{"name":"Department of Infectious Disease Epidemiology London School of Hygiene & Tropical Medicine London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donald M.","family":"Thea","sequence":"additional","affiliation":[{"name":"Department of Global Health Boston University School of Public Health Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juliet O.","family":"Awori","sequence":"additional","affiliation":[{"name":"Kenya Medical Research Institute\u2010Wellcome Trust Research Programme Kilifi Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Chipeta","sequence":"additional","affiliation":[{"name":"Department of Paediatrics and Child Health University Teaching Hospital Lusaka 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