Chest radiograph effective for excluding pediatric pneumonia
Susan C. Lipsett, M.D., from Harvard University in Boston, and colleagues evaluated the negative predictive value of CXR among 683 children (aged 3 months to 18 years) evaluated in a pediatric emergency department for suspected pneumonia over two years. CXR results were classified as positive, equivocal, or negative. Children who had negative CXRs and no clinical diagnosis of pneumonia were managed for two weeks after the emergency department visit, and those diagnosed with pneumonia during the follow-up period were considered to have had false-negative CXRs.
The researchers found that 72.8 percent of children had negative CXRs, with 8.9 percent of these children clinically diagnosed with pneumonia and 9.3 percent given antibiotics for other bacterial syndromes. Five of the 411 children with negative CXRs who were managed without antibiotics were subsequently diagnosed with pneumonia within two weeks (negative predictive value of CXR, 98.8 percent).
"Children with negative CXRs and low clinical suspicion for pneumonia can be safely observed without antibiotic therapy," the authors write.
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