INTRODUCTION
Since 2013, COVID-19 has posed a challenge to the medical community worldwide. Since March of 2020, it began as a pandemic and is now in transition to its endemic phase . Despite all efforts and the introduction of vaccines, it still considered a significant public health concern because it has affected more than 760 million people and caused 6.8 million fatalities worldwide . In addition, infants and adolescents continue to account for 21% of the infected population . Given the supporting evidence for brief and long-term multisystemic complications of COVID-19 , early detection and treatment of this disease in pediatrics and related fields will continue to be essential. Thoracic diagnostic imaging has been an instrument for evaluation of patients with COVID-19 in context of respiratory disease. A growing number of adult and pediatric investigations have focused on describing findings on chest radiography (CXR) and computed tomography (CT) scans.
COVID-19 has been examined using CXR as a diagnostic tool. Current American College of Radiology guidelines, mention this imaging technique as first line for the diagnosis of pediatric patients with COVID-19 who have mild symptoms and comorbidities, or moderate to severe symptoms . Although medical literature characterizes CT scan for this disease mostly normal, when there is a finding the most common ones were glass ground and parabronchial opacities as well as consolidations. This imaging modality has been widely utilized for adult patients; however, it must be considered that the majority of pediatric patients were less likely to have positive chest CT results . In addition, CT is utilized less frequently than CXR due to the elevated risks associated with sedation (when necessary) and the long-term carcinogenic risk for pediatric patients posed by exposure to ionizing radiation .
A group of experts issued a consensus statement on the imaging manifestations of COVID-19 in the pediatric population in 2020, categorizing findings as typical, indeterminate, atypical, and negative . In addition, other pediatric and radiology specialists have attempted to address other general imaging findings in CXR , such as characteristics focusing on zonal predominance , their relationship with specific complications, such as multisystem inflammatory syndrome in children (MIS-C) and even the use of ultrasound (US) and artificial intelligence as alternative tools. Even though there is substantial evidence from studies in the adult population, there is less evidence from studies and smaller sample sizes in the pediatric population.
However, it is essential to recognize that the reported low concordance of radiographic findings in patients with lower respiratory disease is a potential limitation of radiology. This limitation may impact the accuracy and dependability of radiologists ‘interpretations of COVID-19 in pediatric patients. This limitation must be addressed and comprehended in order to ensure the correct application and interpretation of radiological findings in clinical practice.
This study´s primary objective is to characterize the radiological findings in pediatric in-patients with confirmed SARS-CoV2 infection in Colombia between March 2020 and November 2021, with a focus on their relationship to clinical presentation, treatment, and outcomes. In addition, as a secondary objective, we intend to assess the concordance of these radiological findings among radiologists in order to ascertain their true impact on clinical practice.