title: Randomised controlled trial of clinical outcome after chest radiograph in ambulatory acute lower-respiratory infection in children.
abstract: BACKGROUND
  When available, chest radiographs are used widely in acute lower-respiratory-tract infections in children. Their impact on clinical outcome is unknown.
  
  
  METHODS
  522 children aged 2 to 59 months who met the WHO case definition for pneumonia were randomly allocated to have a chest radiograph or not. The main outcome was time to recovery, measured in a subset of 295 patients contactable by telephone. Subsidiary outcomes included diagnosis, management, and subsequent use of health facilities.
  
  
  RESULTS
  There was a marginal improvement in time to recovery which was not clinically significant. The median time to recovery was 7 days in both groups (95% CI 6-8 days and 6-9 days in the radiograph and control groups respectively, p=0.50, log-rank test) and the hazard ratio for recovery was 1.08 (95% CI 0.85-1.34). This lack of effect was not modified by clinicians' experience and no subgroups were identified in which the chest radiograph had an effect. Pneumonia and upper-respiratory infections were diagnosed more often and bronchiolitis less often in the radiograph group. Antibiotic use was higher in the radiograph group (60.8% vs 52.2%, p=0.05). There was no difference in subsequent use of health facilities.
  
  
  CONCLUSIONS
  Chest radiograph did not affect clinical outcome in outpatient children with acute lower-respiratory infection. This lack of effect is independent of clinicians' experience. There are no clinically identifiable subgroups of children within the WHO case definition of pneumonia who are likely to benefit from a chest radiograph. We conclude that routine use of chest radiography is not beneficial in ambulatory children aged over 2 months with acute lower-respiratory-tract infection.
authors.affiliation: Department of Paediatrics and Child Health, Red Cross Children's Hospital and University of Cape Town, Rondebosch, South Africa.
authors.forename: G H
authors.initials: GH
authors.lastname: Swingler
authors.forename: G D
authors.initials: GD
authors.lastname: Hussey
authors.forename: M
authors.initials: M
authors.lastname: Zwarenstein
mesh_terms: D000208:Acute Disease; D000553:Ambulatory Care; D002675:Child, Preschool; D005500:Follow-Up Studies; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D011014:Pneumonia / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000453:epidemiology; D013902:Radiography, Thoracic / Q000706:statistics & numerical data*; D013019:South Africa; D013997:Time Factors; D016896:Treatment Outcome