Chest radiograph in acute respiratory infections in children

Abstract

Background Chest radiography is widely used in children with acute lower respiratory infections, but the benefits are unknown. Objectives To assess the effects of chest radiography for children with acute lower respiratory infections. Search strategy The searches were updated in November 2004. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 1, 2005), MEDLINE (1966 to February, Week 1 2005) and EMBASE (January 1990 to September 2004). We contacted experts in the fields of acute respiratory infections and paediatric radiology to locate additional studies. Selection criteria Randomised or quasi-randomised trials of chest radiography in children with acute respiratory infections. Data collection and analysis One reviewer extracted data and assessed trial quality. Main results We identified only one trial of 522 participants, which was performed by the review authors. The participants were ambulatory children aged two months to five years. Forty-six per cent of both radiography and control participants had recovered by seven days (odds ratio (OR) 1.03, 95% confidence interval (CI) 0.64 to 1.64). Thirty-three per cent of radiography participants and 32% of control participants made a subsequent hospital visit within four weeks (OR 1.02, 95% CI 0.71 to 1.48). Three per cent of both radiography and control participants were subsequently admitted to hospital within four weeks (OR 1.02, 95% CI 0.40 to 2.60). There were no deaths in either group. Authors' conclusions There is no evidence that chest radiography improves outcome in ambulatory children with acute lower respiratory infection. The findings do not exclude a potential effect of radiography, but the potential benefit needs to be balanced against the hazards and expense of chest radiography. The findings apply to ambulatory children only. PLAIN LANGUAGE SUMMARY There is not enough evidence that chest x-rays help in the treatment of children with acute respiratory infections Chest x-rays are often used to try and determine whether a child has pneumonia. It is not clear, however, that the diagnosis with x-rays is accurate enough to be useful. There was only one trial found, which tested chest x-rays for children who had symptoms for less than two weeks and were not so ill they had to be in bed. Children who were x-rayed did not recover more quickly. There are also harms to be considered but were not, including cost and potential risks of radiation. Copyright © 2006 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd