What is the role of chest radiography in occult pneumonia evaluation?

To determine the incidence of occult pneumonia among children who have chest radiography (CXR) and to identify clinical predictors of occult pneumonia, researchers conducted a prospective observational study in an urban pediatric emergency department. The study group consisted of 308 children (mean age, 5.2 years) for whom a CXR was ordered to exclude occult pneumonia.

Of these children, who were febrile but had neither respiratory distress nor lower respiratory tract findings on physical exam, 21 (6.8%) had radiographic occult pneumonia.

Age, height of fever, duration or quality of cough, and pulse oximetry were not associated with the diagnosis.

No patient with fever for a shorter time than 1 day and without any cough or without worsening cough had pneumonia.

The researchers recommend not obtaining a CXR for detection of occult pneumonia in children without cough and with fever that has lasted for a shorter period than 1 day (Shah S, et al. Pediatr Emerg Care. 2010;26[9]:615-621).

COMMENTARY

These investigators in Boston have been considering the problem of occult pneumonia in children for more than a decade. They continue to evaluate this clinical concern against a shifting background of prevalence of pneumococcal disease. Their patience is admirable and their recommendations are valuable.
-Michael Burke, MD