Does the lateral chest radiograph help pediatric emergency physicians diagnose pneumonia? A randomized clinical trial.
OBJECTIVE
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.
Lynch
Tim
T
Department of Pediatrics, Children's Hospital of Western Ontario, London, Ontario, Canada. tim.lynch@lhsc.on.ca
Gouin
Serge
S
Larson
Charles
C
Patenaude
Yves
Y
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004632:Emergency Medical Services / Q000379:methods*; D004635:Emergency Medicine / Q000379:methods*; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010372:Pediatrics / Q000379:methods*; D011014:Pneumonia / Q000000981:diagnostic imaging*; D013902:Radiography, Thoracic / Q000379:methods*; D012680:Sensitivity and Specificity