Chest Radiograph for Childhood Pneumonia: Good, but Not Good Enough

• Published in: Pediatrics (Evanston) 2018-09, Vol.142 (3), p.1
• Main Authors: Garber, Matthew D, Quinonez, Ricardo A
• Format: Article
• Language: English
• Subjects: Antibiotics; Bacteria; Chest; Children; Children & youth; Deaths; Developing countries; Diagnosis; LDCs; Medical personnel; Pediatrics; Pneumonia; Radiography; Viruses
• ISSN: 0031-4005; 1098-4275
• DOI: 10.1542/peds.2018-2025

Pneumonia is the greatest killer of children worldwide, with 920136 deaths in children in 2015. Although less lethal in developing countries like the US, the burden is still considerable, with annual ambulatory visit rates for community-acquired pneumonia (CAP) in US children of 16.9 to 22.4 per 1000 in the population. Although CAP is a clinical diagnosis, individual signs and symptoms have poor prognostic value, and children may undergo radiography to confirm or disprove the diagnosis. Although both viruses and bacteria can cause CAP, physicians are generally trying to rule out a bacterial infection with a chest radiograph (CXR) because the main clinical decision is whether to prescribe antibiotics. Physicians should take comfort in the fact that CXR for CAP has a high NPV. However, another possibility is that some or most of the children in this study who were diagnosed with pneumonia in the ED did not have bacterial pneumonia.