Chest X-Rays Effectively Exclude Pediatric Pneumonia

Children with low clinical suspicion for pneumonia and a negative chest radiograph and can be safely observed without resorting to antibiotic therapy, claims a new study.

Researchers at Harvard University (Cambridge, MA, USA) and Boston Children’s Hospital (BCH; MA, USA) conducted a study that included 683 children during a two-year study period in order to determine the negative predictive value of chest x-rays in pediatric suspected pneumonia. Children receiving antibiotics and those with underlying chronic medical conditions were excluded. The primary outcome was defined as a physician-ascribed diagnosis of pneumonia, independent of radiographic findings.


Children who had negative X-rays and no clinical diagnosis of pneumonia were managed for two weeks after the emergency department visit, with those diagnosed with pneumonia during the follow-up period considered as false-negatives. In all, 72.8% of the children had negative radiographic findings, 8.9% were clinically diagnosed with pneumonia, and 9.3% were given antibiotics for other bacterial syndromes. Five of the 411 children with negative X-rays managed without antibiotics were later diagnosed with pneumonia, representing a negative predictive value of 98.8%. The study was published in the September 2018 issue of Pediatrics.

“Most clinicians caring for children in the outpatient setting rely on clinical signs and symptoms to determine whether to prescribe an antibiotic for the treatment of pneumonia,” concluded lead author Susan Lipsett, MD, of Harvard University, and colleagues. “However, given recent literature in which the poor reliability and validity of physical examination findings are cited, reliance on physical examination alone may lead to the overdiagnosis of pneumonia.”

Pneumonia is the greatest killer of children worldwide, with over 920,000 reported deaths in 2015 alone. The World Health Organization (WHO) clinical definition of pneumonia is based on the presence of cough and tachypnoea. While highly sensitive, the definition cannot distinguish between viral and bacterial infection. As a result, chest radiographs are widely employed, with a spectrum of radiological finding available to differentiate between complicated pneumonia (e.g. pneumonia with empyema and necrotizing pneumonia), simple pneumonia (e.g. lobar consolidation), and mild interstitial changes.

Related Links:
Harvard University
Boston Children’s Hospital