Editor’s Note: Katie is a telephone triage nurse with a background in women’s and children’s health. She is also the mother of two neurodiverse teens with medical complexities. -Cara L. Coleman, JD, MPH
Pneumonia can be a frightening word for parents to hear. Learning that your child doesn’t have pneumonia can be comforting, but only if you can be confident that the news is accurate.
Since many symptoms of pneumonia are similar to other respiratory illnesses, chest X-rays (CXR) are often used in urgent care or emergency departments to decide whether an illness is pneumonia or not. But how reliable is a negative CXR in telling whether a child turns out to have pneumonia?
In this month’s Pediatrics, “Risk of Subsequent Pneumonia after a Negative Chest X-Ray in the ED” by Hirsch et al. discusses a study assessing how often children developed “radiologic pneumonia” (a positive CXR) after the first one was negative (10.1542/peds.2024-069829).
What is pneumonia?
Pneumonia is an infection of the lower part of the respiratory tract (the area from the windpipe down to the lungs). It is treated differently than infections of the upper respiratory tract (the nose and throat) and also treated differently than other lower respiratory tract conditions.
What types of testing can diagnose pneumonia?
CXR can look for changes in the lung, such as the appearance of fluid, often caused by pneumonia. The diagnosis can also be made by a healthcare provider interpreting symptoms and vital signs.
This study focused on x-rays and defined “radiographic pneumonia” or “positive CXR” as those the radiologist described as “either definite or probable pneumonia.”
Why does this matter?
Waiting too long for the right treatment can allow an infection to get dangerously out of control. A wrong diagnosis could also lead to the wrong treatments, or no treatment.
What did the study look for?
- Whether an initial negative CXR accurately predicted that a child was not likely to later (within 14 days) have a positive one.
- Whether some children have some factors that make a negative CXR followed by a positive one more likely.
Children with certain chronic medical conditions, like cancer, or those admitted to intensive care were not included, so the authors note that children with complex medical conditions may need more thorough evaluation before saying for sure they don’t have pneumonia.
What did the study find?
- Most children with a negative CXR did not later develop pneumonia.
- Factors that made it more likely for a child to fit the rare category of having pneumonia after an initial negative X-ray included children who:
- Had asthma.
- Had fast breathing (tachypnea) or hypoxemia (low oxygen levels) during the first medical visit.
What can you do with this article?
- If your child is at risk for pneumonia, or has asthma, you can share this article with their doctor to help ask questions about tests and treatment.
- If your child was evaluated for pneumonia or another breathing concern and is worsening or not improving, call your doctor or have your child seen again. Breathing problems should always be taken seriously, whether or not they are thought to be pneumonia.
