Accuracy of the Interpretation of Chest Radiographs for the Diagnosis of Paediatric Pneumonia

Introduction: World Health Organization (WHO) radiological classification remains an important entry criterion in epidemiological studies of pneumonia in children. We report inter-observer variability in the interpretation of 169 chest radiographs in children suspected of having pneumonia.Methods: An 18-month prospective aetiological study of pneumonia was undertaken in Northern England. Chest radiographs were performed on eligible children aged <= 16 years with clinical features of pneumonia. The initial radiology report was compared with a subsequent assessment by a consultant cardiothoracic radiologist. Chest radiographic changes were categorised according to the WHO classification.Results: There was significant disagreement (22%) between the first and second reports (kappa = 0.70, P<0.001), notably in those aged <5 years (26%, kappa = 0.66, P<0.001). The most frequent sources of disagreement were the reporting of patchy and perihilar changes.Conclusion: This substantial inter-observer variability highlights the need for experts from different countries to create a consensus to review the radiological definition of pneumonia in children

Utility of inflammatory markers in predicting the aetiology of pneumonia in children

We aimed to investigate the diagnostic value of applying cut-off levels of inflammatory markers and to develop a prediction model for differentiation between bacterial and viral infections in paediatric community-acquired pneumonia based on C-reactive protein (CRP), neutrophil, and white cell counts (WCC). Amongst 401 children, those with bacterial pneumonia were older than those with viral pneumonia (P < 0.001). Compared to viral, bacterial infections had a higher median CRP level (P < 0.001), Whereas WCC and neutrophil count were not different. Bacterial infections were associated with higher CRP >80 mg/L than viral infections (P = 0.001), but levels <20 mg/L were not discriminatory (P = 0.254). Receiver operating characteristic curve of the model for differentiating bacterial from viral pneumonia based on age, CRP, and neutrophil count produced area under the curve of 0.894 with 75.7% sensitivity and 89.4% specificity. This aetiological discriminant prediction model is a potentially useful tool in clinical management and epidemiological studies of paediatric pneumonia. (C) 2014 The Authors. Published by Elsevier Inc