Does the lateral chest radiograph help pediatric emergency physicians diagnose pneumonia? A randomized clinical trial

Abstract

Objectives: 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.