ACR Appropriateness Criteria® Pneumonia in the Immunocompetent Child
, Sherwin S Chan1, Manish K Kotecha2
1Children's Mercy Hospital, Kansas City, Missouri.
Insights
Pneumonia diagnosis in immunocompetent children is clinical. Imaging is crucial for detecting complications like pleural effusion and guiding evaluation of recurrent pneumonia causes.
Area of Science:
- Pediatric Infectious Diseases
- Medical Imaging in Pediatrics
- Clinical Diagnostics
Background:
- Pneumonia is a leading infectious cause of death in children globally.
- Diagnosis of uncomplicated community-acquired pneumonia in immunocompetent children is primarily clinical.
- Imaging plays a critical role in identifying pneumonia complications and underlying anatomical issues.
Framework:
- Radiographs are recommended for initial screening of pneumonia complications.
- Ultrasound and Computed Tomography (CT) are utilized for confirming complications such as pleural effusion and pulmonary abscess.
- Contrast-enhanced CT is the preferred imaging modality for evaluating anatomical predispositions to recurrent pneumonia.
Implementation:
- The American College of Radiology Appropriateness Criteria provide evidence-based guidelines for imaging in pneumonia.
- Guidelines are developed and revised annually by a multidisciplinary expert panel.
- Methodologies like RAND/UCLA Appropriateness Method and GRADE are used to assess imaging procedure appropriateness.
Implications:
- Appropriate use of imaging can improve the detection of serious pneumonia complications.
- Imaging guidelines aid clinicians in selecting the most effective diagnostic procedures.
- Expert opinion supplements evidence for equivocal cases, ensuring comprehensive patient care.
Abstract:
Pneumonia is one of the most common acute infections and the single greatest infectious cause of death in children worldwide. In uncomplicated, community-acquired pneumonia in immunocompetent patients, the diagnosis is clinical and imaging has no role. The first role of imaging is to identify complications associated with pneumonia such as pleural effusion, pulmonary abscess, and bronchopleural fistula. Radiographs are recommended for screening for these complications and ultrasound and CT are recommended for confirmation. The second role of imaging is to identify underlying anatomic conditions that may predispose patients to recurrent pneumonia. CT with intravenously administered contrast is recommended for this evaluation. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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