title: Detection failure rate of chest radiography for the identification of nursing and healthcare-associated pneumonia.
abstract: OBJECTIVE
  To clarify the detection failure rate of chest radiography for the identification of nursing and healthcare-associated pneumonia (NHCAP), we compared high-resolution computed tomography (HRCT) with chest radiography simultaneously for patients with clinical symptoms and signs leading to a suspicion of NHCAP.
  
  
  METHODS
  We analyzed 208 NHCAP cases and compared them based on four groups defined using NHCAP criteria, patients who were: Group A) resident in an extended care facility or nursing home; Group B) discharged from a hospital within the preceding 90 days; Group C) receiving nursing care and had poor performance status; and Group D) receiving regular endovascular treatment.
  
  
  RESULTS
  Chest radiography was inferior to HRCT for the identification of pneumonia (149 vs 208 cases, p < 0.0001). Among the designated NHCAP criteria, chest radiography identified pneumonia cases at a significantly lower frequency than HRCT in Group A (70 vs 97 cases, p = 0.0190) and Group C (86 vs 136 cases, p < 0.0001). The detection failure rate of chest radiography differed among NHCAP criteria; 27.8% in Group A, 26.5% in Group B, 36.7% in Group C and 5.8% in Group D. Cerebrovascular disease and poor functional status were significantly more frequent in patients in Groups A and C compared with those in Groups B and D.
  
  
  CONCLUSIONS
  Physicians may underestimate pneumonia shadow in chest radiographs in patients with NHCAP, and the detection failure rate of chest radiography differed among NHCAP criteria. Poor functional status may correlate with the low accuracy of chest radiography in diagnosing pneumonia.
authors.affiliation: Department of Internal Medicine I, Kawasaki Medical School, Okayama, Japan. Electronic address: nao@med.kawasaki-m.ac.jp.
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Miyashita
authors.affiliation: Department of Internal Medicine I, Kawasaki Medical School, Okayama, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Kawai
authors.affiliation: Department of Pediatrics, Kawasaki Medical School, Okayama, Japan.
authors.forename: Takaaki
authors.initials: T
authors.lastname: Tanaka
authors.affiliation: Department of Pediatrics, Kawasaki Medical School, Okayama, Japan.
authors.forename: Hiroto
authors.initials: H
authors.lastname: Akaike
authors.affiliation: Department of Pediatrics, Kawasaki Medical School, Okayama, Japan.
authors.forename: Hideto
authors.initials: H
authors.lastname: Teranishi
authors.affiliation: Department of Pediatrics, Kawasaki Medical School, Okayama, Japan.
authors.forename: Tokio
authors.initials: T
authors.lastname: Wakabayashi
authors.affiliation: Department of Pediatrics, Kawasaki Medical School, Okayama, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Nakano
authors.affiliation: Department of Pediatrics, Kawasaki Medical School, Okayama, Japan.
authors.forename: Kazunobu
authors.initials: K
authors.lastname: Ouchi
authors.affiliation: Department of Internal Medicine I, Kawasaki Medical School, Okayama, Japan.
authors.forename: Niro
authors.initials: N
authors.lastname: Okimoto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003428:Cross Infection / Q000000981:diagnostic imaging* / Q000453:epidemiology; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000000981:diagnostic imaging* / Q000453:epidemiology; D013902:Radiography, Thoracic / Q000706:statistics & numerical data*; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*
keywords: Aspiration; Chest radiograph; Detection failure rate; High-resolution computed tomography; Nursing and healthcare-associated pneumonia; Performance status