Susan C. Lipsett
Pneumonia can be ruled out for most children with a suspected diagnosis but a negative chest radiograph, or CXR, according to research published in Pediatrics. Researchers noted that most of these children can be monitored without needing treatment with antibiotics.
“The majority of children who have respiratory symptoms but negative CXRs will recover on their own without antibiotics,” Susan C. Lipsett, MD, assistant in medicine in the division of emergency medicine at Boston Children’s Hospital and an instructor in pediatrics at Harvard Medical School, told Infectious Diseases in Children. “In my opinion, these results are not surprising as the majority of respiratory illnesses in children are viral in origin. However, demonstrating the high negative predictive value of CXR in a large prospective cohort may help to mitigate the concern that CXRs are insensitive for the diagnosis of pneumonia.”
To examine the rate in which CXR could exclude pneumonia diagnosis in suspected cases, Lipsett and colleagues conducted a prospective analysis that included children aged between 3 months and 18 years presenting to a tertiary-care pediatric ED who received a CXR for suspected pneumonia. Only children already receiving antibiotic treatment and those with an underlying medical condition were excluded.
During the 2 years in which the study was conducted, 683 children received a CXR. Most of these children (72.8%) had negative CXRs. Of those with negative imaging, 8.9% were diagnosed. Although a diagnosis was received for a small portion of those receiving a CXR, more children received antibiotics — 9.3% — for other bacterial symptoms.
The researchers noted that of those with a negative CXR who did not receive antibiotics, five patients were later diagnosed with pneumonia up to 2 weeks after imaging (negative predictive value of CXR, 98.8%; 95% CI, 97%-99.6%).
“While antibiotic use despite a negative CXR may be appropriate in certain subgroups of children, including the very ill, the majority of children with negative CXRs and no other identifiable bacterial infection do not require antibiotics,” Lipsett said. “Use of antibiotics in the setting of a negative CXR may lead to increased antibiotic resistance and harmful side effects. In our study, the vast majority of children who were observed without antibiotics fully recovered within 2 weeks of their ED visit.”
Lipsett said that this information may be helpful for pediatricians in counseling parents about the expected duration of respiratory symptoms in children with a negative CXR. – by Katherine Bortz
Disclosures: The authors report no relevant financial disclosures.