Is the frontal radiograph alone sufficient to evaluate for pneumonia in children?

In our cost- and radiation-conscious environment, the feasibility of performing only a frontal radiograph for the diagnosis of pneumonia in children needs to be reassessed.

To determine the diagnostic efficacy of the frontal radiograph alone in comparison to the frontal and lateral combined radiographs for the radiographic diagnosis of pneumonia in children.

Three radiologists retrospectively and independently reviewed the frontal radiographs alone and separately reviewed the frontal and lateral radiographs of 1,268 children referred from the emergency room for chest radiographs. A majority interpretation of at least two radiologists for the frontal views alone was compared with majority interpretation of the frontal and lateral combined views for the radiographic diagnosis of pneumonia. "Pneumonia" was defined as a focus of streaky or confluent lung opacity.

For the radiographic diagnosis of pneumonia, the sensitivity and specificity of the frontal view alone were 85% and 98%, respectively. For the confluent lobar type of pneumonia, the sensitivity and specificity increased to 100%.

When the frontal view alone yields a diagnosis of confluent lobar pneumonia, this is highly reliable. However, nonlobar types of infiltrates will be underdiagnosed in 15% of patients using the frontal view alone. The clinical impact of these radiographically underdiagnosed pneumonias needs to be assessed prior to implementing the practice of using only frontal radiographs for diagnosing pneumonia.