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Chest radiograph in acute respiratory infections in children
1Department of Paediatrics and Child Health, Institute of Child Health, Red Cross Children's Hospital, Klipfontein Road, Rondebosch, Cape Town, South Africa, 7700. swingler@ich.uct.ac.za
Insights
Chest X-rays do not improve outcomes for children with acute lower respiratory infections. This study found no evidence of benefit, but potential risks and costs should be considered.
Area of Science:
- Pediatric Medicine
- Radiology
- Infectious Diseases
Background:
- Chest radiography is commonly used for pediatric acute lower respiratory infections.
- The clinical benefits of routine chest X-rays in these cases remain unclear.
Purpose of the Study:
- To evaluate the effectiveness of chest radiography in managing acute lower respiratory infections in children.
- To determine if chest X-rays impact recovery rates, hospital visits, or admissions.
Main Methods:
- Systematic review of randomized and quasi-randomized controlled trials.
- Searched major medical databases and contacted experts for relevant studies up to December 1999.
- Included one trial with 522 ambulatory children aged two months to five years.
Main Results:
- No significant difference in recovery rates by day seven between radiography and control groups (OR 1.03, 95% CI 0.64-1.64).
- Similar rates of subsequent hospital visits and admissions within four weeks for both groups.
- No deaths were reported in either the radiography or control group.
Conclusions:
- Current evidence does not support the use of chest radiography for ambulatory children with acute lower respiratory infections.
- The potential benefits of chest X-rays must be weighed against their associated risks and costs.
- Findings are specific to ambulatory pediatric populations and do not exclude benefits in other settings.
Background:
Chest radiography is widely used in acute lower respiratory infection in children, but the benefits are unknown.
Objectives:
To assess the effects of chest radiography for children with acute lower respiratory infections.
Search Strategy:
We searched the Cochrane Respiratory Infections Group trials register, the Cochrane Controlled Trials Register and MEDLINE up to December 1999. We contacted experts in the fields of acute respiratory infections and paediatric radiology to locate additional studies.
Selection Criteria:
Randomised or quasi-randomised trials of chest radiography in acute respiratory infections in children.
Data Collection And Analysis:
One reviewer extracted data and assessed trial quality.
Main Results:
We identified only one trial of 522 participants, performed by the reviewers. The participants were ambulatory children aged two months to five years. Forty six percent of both radiography and control participants had recovered by seven days - odds ratio (1.03, 95% confidence interval 0.64 to 1.64). Thirty three percent of radiography participants and 32% of control participants made a subsequent hospital visit within four weeks - odds ratio 1.02 (95% confidence interval 0.71 to 1.48). Three percent of both radiography and control participants were subsequently admitted to hospital within four weeks - odds ratio 1.02 (95% confidence interval 0.40 to 2.60). There were no deaths in either group.
Reviewer'S Conclusions:
There is no evidence that chest radiography improves outcome in ambulatory children with acute lower respiratory infection. The findings do not exclude a potential effect of radiography, but the potential benefit needs to be balanced against the hazards and expense of chest radiography. The findings apply to ambulatory children only.