The role of chest radiograph (CXR) among children with community-acquired pneumonia is controversial. We aimed to assess if there is association between a specific etiology and radiologically confirmed pneumonia.
This was a prospective cross-sectional study. Based on report of respiratory complaints and fever/difficulty breathing plus the detection of pulmonary infiltrate/pleural effusion on the CXR taken upon admission read by the pediatrician on duty, children <5-year-old hospitalized with community-acquired pneumonia were enrolled. On admission, clinical data and biological samples were collected to investigate 19 etiological agents (11 viruses and 8 bacteria). CXR taken upon admission was independently read by a pediatric radiologist blinded to clinical data.
The study group comprised 209 cases with evaluated CXR and establishment of a probable etiology. Radiologically confirmed pneumonia, normal CXR and other radiographic diagnoses were described for 165 (79.0%), 36 (17.2%) and 8 (3.8%) patients, respectively. Viral infection was significantly more common among patients without radiologically confirmed pneumonia (68.2% vs. 47.9%; P = 0.02), particularly among those with normal CXR (66.7% vs. 47.9%; P = 0.04) when compared with patients with radiologically confirmed pneumonia. Bacterial infection was more frequent among cases with radiologically confirmed pneumonia (52.1% vs. 31.8%; P = 0.02). Likewise, pneumococcal infection was more frequently detected among children with radiologically confirmed pneumonia in regard to children with normal CXR (24.2% vs. 8.3%; P = 0.04). Sensitivity (95% confidence interval) of radiologically confirmed pneumonia for pneumococcal infection was 93% (80–98%), and negative predictive value (95% confidence interval) of normal CXR for pneumococcal infection was 92% (77–98%).
Bacterial infection, especially pneumococcal one, is associated with radiologically confirmed pneumonia.
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From the *Department of Pediatrics and †Department of Image Diagnosis, Federal University of Bahia School of Medicine, Salvador, Brazil; and ‡Department of Pediatrics, University of Turku, Turku, Finland.
Accepted for publication November 7, 2014.
This study was supported by the Bahia State Agency for Research Funding (FAPESB; grant number 52/2004) and the Brazilian Council for Scientific and Technological Development (CNPq; grant number 03551/2011–9) in Brazil and the Pediatric Research Foundation, in Finland.
C.M.N.-C. is an investigator at the Brazilian Council for Scientific and Technological Development (CNPq). The authors have no conflicts of interest to disclose.
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Address for correspondence: Cristiana M. Nascimento-Carvalho, MD, PhD, Department of Pediatrics, Federal University of Bahia School of Medicine, Rua Prof. Aristides Novis, 105/1201B, Salvador, Bahia, CEP 40210-630, Brazil. E-mail: firstname.lastname@example.org.