Related Experiment Videos
Radiographic findings and etiologic diagnosis in ambulatory childhood pneumonias
Abstract:
The chest roentgenograms of 128 consecutive ambulatory children with radiologic pneumonia were read independently and without clinical information by a faculty general pediatrician (Ped), a pediatric radiologist (R-P) and a general radiologist (R-G). The films were classified as normal, indicative of a viral or bacterial process, or indeterminate. Readings were compared with results of viral titers and bacterial cultures. Agreement between any two observers in classifying films, measured by unweighted Kappa, while statistically significant (p less than 0.001) for any pair, was low. There was no significant difference between the agreement scores of Ped/R-P, Ped/R-G, and R-P/R-G. Twenty-one patients had fourfold viral titer increases (N = 16) or positive bacterial cultures of blood or pulmonary aspirate (N = 5). The sensitivity of viral readings for titers increases varied from 19% to 68% depending on observer type; the sensitivity of bacterial readings for positive bacterial cultures varied from 60% to 80%. The three observers agreed on a correct reading in only three children with viral and three with bacterial pneumonia. Because of poor observer agreement and appreciable false-negative errors when viral and bacterial readings were compared to titer increases and positive bacterial cultures, respectively, we conclude that radiographic findings are poor indicators of etiology diagnosis in ambulatory childhood pneumonias and, of themselves, are an insufficient data base for making therapeutic decisions.
Insights
Radiographic findings in childhood pneumonia show poor agreement among doctors and are unreliable for determining viral or bacterial causes. Chest X-rays alone are insufficient for diagnosing pneumonia etiology or guiding treatment decisions.
Area of Science:
- Pediatric Medicine
- Radiology
- Infectious Diseases
Background:
- Accurate diagnosis of pneumonia etiology in children is crucial for appropriate treatment.
- Chest roentgenograms are commonly used to evaluate pediatric pneumonia.
- Determining whether pneumonia is viral or bacterial impacts therapeutic decisions.
Observation:
- 128 ambulatory children with radiologic pneumonia had chest X-rays interpreted by a pediatrician and two radiologists.
- Inter-observer agreement for classifying pneumonia as normal, viral, bacterial, or indeterminate was low, despite statistical significance.
- Sensitivity of radiographic interpretation for identifying viral or bacterial infections varied significantly by observer.
Findings:
- Low agreement was observed among all pairs of observers (pediatrician, pediatric radiologist, general radiologist).
- Sensitivity for detecting viral infections ranged from 19% to 68%, and for bacterial infections from 60% to 80%.
- Correct etiological diagnosis based on X-rays was achieved in only 6 children (3 viral, 3 bacterial).
Implications:
- Radiographic findings are poor indicators of the specific cause (viral vs. bacterial) of childhood pneumonia.
- Chest X-ray interpretation alone is an insufficient basis for making treatment decisions in pediatric pneumonia.
- Further diagnostic methods are needed to accurately determine pneumonia etiology in children.