Is the frontal radiograph alone sufficient to evaluate for pneumonia in children?
Purchase on Springer.com
$39.95 / €34.95 / £29.95*
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.
In our cost- and radiation-conscious environment, the feasibility of performing only a frontal radiograph for the diagnosis of pneumonia in children needs to be reassessed.
To determine the diagnostic efficacy of the frontal radiograph alone in comparison to the frontal and lateral combined radiographs for the radiographic diagnosis of pneumonia in children.
Materials and methods
Three radiologists retrospectively and independently reviewed the frontal radiographs alone and separately reviewed the frontal and lateral radiographs of 1,268 children referred from the emergency room for chest radiographs. A majority interpretation of at least two radiologists for the frontal views alone was compared with majority interpretation of the frontal and lateral combined views for the radiographic diagnosis of pneumonia. “Pneumonia” was defined as a focus of streaky or confluent lung opacity.
For the radiographic diagnosis of pneumonia, the sensitivity and specificity of the frontal view alone were 85% and 98%, respectively. For the confluent lobar type of pneumonia, the sensitivity and specificity increased to 100%.
When the frontal view alone yields a diagnosis of confluent lobar pneumonia, this is highly reliable. However, nonlobar types of infiltrates will be underdiagnosed in 15% of patients using the frontal view alone. The clinical impact of these radiographically underdiagnosed pneumonias needs to be assessed prior to implementing the practice of using only frontal radiographs for diagnosing pneumonia.
- Kirks DR (1991) Practical imaging: diagnostic radiology of infants and children, 2nd edn. Little, Brown, Boston, pp 516–519
- Fraser RG, Paré JAP (1978) Diagnosis of diseases of the chest, 2nd edn. Saunders, Philadelphia, pp 185–186
- Obuchowski NA, Zepp RC (1996) Simple steps for improving multiple-reader studies in radiology. AJR 166:517–521
- Lamme T, Nijout M, Cadman D, et al (1986) Value of the lateral radiologic view of the chest in children with acute pulmonary illness. Can Med Assoc J 134:353–356
- Bartko JJ, Carpenter WT (1976) On the methods and theory of reliability. J Nerv Ment Dis 163:307–313
- Grossman LK, Caplan S (1988) Clinical, laboratory, and radiological information in the diagnosis of pneumonia in children. Ann Emerg Med 17:43–46
- Kiekara O, Korppi M, Tanska S, et al (1996) Radiological diagnosis of pneumonia in children. Ann Med 28:69–72
- Albaum MN, Hill LC, Miles M, et al (1996) Interobserver reliability of the chest radiograph in community-acquired pneumonia. Chest 110:343–350
- Kennedy J, Dawson KP, Abbott GD (1986) Should a lateral chest radiograph be routine in suspected pneumonia? Aust Pediatr J 22:299–230
- Patenaude Y, Blais C, Leduc CP (1995) Reliability of frontal chest X-ray in diagnosing pulmonary opacities in children. Invest Radiol 30:44–48
- Melbye H, Dale K (1992) Interobserver variability in the radiographic diagnosis of adult outpatient pneumonia. Acta Radiol 33:79–81
- Anonymous Editorial (1998) Pneumonia in childhood. The Lancet 1:741–743
- Davies HD, Wang EEL, Manson D, et al (1996) Reliability of the chest radiograph in the diagnosis of lower respiratory infections in young children. Pediatr Infect Dis J 15:600–604 CrossRef
- Thornbury JR (1994) Clinical efficacy of diagnostic imaging: love it or leave it. AJR 162:1–8
- Is the frontal radiograph alone sufficient to evaluate for pneumonia in children?
Volume 34, Issue 5 , pp 379-383
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Respiratory system
- Industry Sectors
- Author Affiliations
- 1. Department of Radiology, Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
- 3. Department of Medical Imaging No. 9, Children’s Memorial Hospital, 2300 Children’s Plaza, Chicago, IL 60614, USA
- 2. Department of Health Policy and Clinical Effectiveness, Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
- 4. Wake Forest University Baptist Medical Center, Department of Radiology, Meads Hall, 2nd Floor, Winston-Salem, NC 27157, USA