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Chest radiography in ambulatory children with acute lower respiratory infections: effective tuberculosis
1Department of Paediatrics and Child Health, Red Cross Children's Hospital, Cape Town, South Africa. swingler@ich.uct.ac.za
Insights
Routine chest X-rays in young children with acute lower respiratory infections rarely change tuberculosis management. This study found minimal impact on diagnosis for children without prolonged cough or known TB contact.
Area of Science:
- Pediatrics
- Infectious Diseases
- Radiology
Background:
- Acute lower respiratory infections (ALRI) are common in young children.
- Tuberculosis (TB) is prevalent in certain regions, posing diagnostic challenges.
- Chest radiography is often used in ALRI diagnosis, but its utility for detecting TB in this context is unclear.
Purpose of the Study:
- To determine the proportion of ambulatory children with ALRI whose clinical management was altered by chest radiography findings suggestive of tuberculosis.
- To evaluate the impact of routine chest X-rays on tuberculosis diagnosis in a high-prevalence setting.
Main Methods:
- Study included 273 ambulatory children aged 2-59 months meeting the WHO case definition for pneumonia.
- Exclusion criteria: cough >14 days, known household contact with active TB.
- Chest radiography findings suggestive of TB were analyzed for their impact on clinical management.
Main Results:
- Twelve children (4.4%) had radiological findings suggesting TB, with nine showing suspected mediastinal lymphadenopathy.
- Eight children were investigated further for TB; seven did not require TB treatment, and one was lost to follow-up.
- Chest radiography did not lead to a significant increase in TB diagnoses.
Conclusions:
- Routine chest radiography in ambulatory children with short-duration ALRI and no known TB contact does not significantly increase TB diagnosis.
- The diagnostic yield of chest X-rays for TB in this specific pediatric population is low.
- Clinical management is generally not meaningfully changed by these radiographic findings.
Abstract:
A study was performed to determine the proportion of ambulatory children with acute lower respiratory infections in whom clinical management was changed by findings on routine chest radiography that suggested tuberculosis. The children studied were aged between 2 and 59 months and met the World Health Organization's case definition for pneumonia. They lived in an area with a very high prevalence of tuberculosis. Exclusion criteria included a cough of more than 14 days' duration and a history of a current household contact with active tuberculosis. Twelve (4.4%) of 273 children had radiological findings suggesting tuberculosis, nine of which were suspected mediastinal lymphadenopathy. Eight children were further investigated for tuberculosis: seven of them did not require treatment for tuberculosis and one was lost to follow-up. It is concluded that chest radiography in ambulatory children with acute lower respiratory infections of less than 14 days' duration and not in contact with active tuberculosis does not result in a meaningful increase in the diagnosis of tuberculosis.