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Does the lateral chest radiograph help pediatric emergency physicians diagnose pneumonia? A randomized clinical trial
Tim Lynch1, Serge Gouin, Charles Larson
1Department of Pediatrics, Children's Hospital of Western Ontario, London, Ontario, Canada. tim.lynch@lhsc.on.ca
Insights
Adding a lateral chest X-ray did not improve pediatric emergency physicians' accuracy in diagnosing childhood pneumonia. The study found no significant difference in sensitivity or specificity when using both frontal and lateral views.
Area of Science:
- Pediatric Emergency Medicine
- Diagnostic Imaging
- Radiology
Background:
- Pneumonia is a common pediatric emergency department diagnosis.
- Chest radiography is frequently used to confirm pneumonia.
- The diagnostic utility of adding a lateral view to frontal chest X-rays in children is debated.
Purpose of the Study:
- To evaluate if adding a lateral chest radiograph improves pediatric emergency physicians' diagnostic accuracy for pneumonia.
- To assess the impact on management decisions for pediatric pneumonia.
Main Methods:
- A randomized clinical trial involving 570 children (1-16 years) with suspected pneumonia.
- Physicians reviewed frontal films only (Group 1) or both frontal and lateral films (Group 2).
- Interpretations were compared against a consensus of pediatric radiologists.
Main Results:
- No significant difference in sensitivity (91% vs 87%, p=0.321) or specificity (58% vs 57%, p=0.888) between groups.
- The addition of the lateral view did not enhance diagnostic performance.
Conclusions:
- The lateral chest radiograph does not improve the diagnostic accuracy of pediatric emergency physicians for childhood pneumonia.
- Routine addition of lateral views may not be necessary for diagnosing pediatric pneumonia.
Objectives:
To determine whether the addition of the lateral chest radiograph to the frontal view influences the pediatric emergency physician's diagnosis and management of patients with pneumonia.
Methods:
A randomized clinical trial was conducted, involving 570 patients, 1-16 years of age, visiting a pediatric emergency department (ED) for whom frontal and lateral chest radiographs were ordered for the clinical suspicion of pneumonia. Pediatric emergency physicians reviewed the frontal film alone in group 1 and both the frontal and the lateral films in group 2. The interpretation of each radiograph was then compared with consensus interpretation by pediatric radiologists who interpreted both views.
Results:
There were 604 eligible children; 34 families declined to participate. Three hundred three were randomized into group 1, whereas 267 were randomized into group 2. The clinicians' interpretations were equal in sensitivity for group 1 at 91% and 87% in group 2 (p = 0.321) and equal in specificity for group 1 at 58% and 57% in group 2 (p = 0.888).
Conclusions:
The addition of the lateral chest radiograph to the frontal view did not improve the sensitivity or specificity of pediatric emergency physicians in their diagnosis of pneumonia in children.
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