pem pearl: Development of pneumonia after negative chest x-ray
Ever heard that chest x-ray findings lag behind clinical findings? Or that a pneumonia might "blossom" once the patient receives IV fluids? This article puts these teachings to the test...
A retrospective chart review study from a large tertiary pediatric center looked at 10 years of data. They wanted to know how many kids ended up developing pneumonia after an initially negative CXR.
Nearly 10,000 children were included, with only 240 (2.4%) returning for a repeat x-ray within 2 weeks of the index visit. Of these, only 27 developed pneumonia. That's 0.27%, or 1 in 370, of the nearly 10,000 that had a negative chest x-ray initially.
Factors found at the index visit that were associated with subsequent development of pneumonia were tachypnea, hypoxemia, and signs of dehydration. Of those who developed PNA after initially negative CXR, about half were admitted, and about 1/3 had symptoms for less than 3 days at the index visit.
Bottom Line: Development of pneumonia after a negative chest xray is quite rare (0.27% based on this relatively large study). Watch out for specific findings such as tachypnea, hypoxemia, and signs of dehydration. I think this also highlights the importance of REALLY GOOD RETURN PRECAUTIONS. Tell parents to come back if their child develops X, Y or Z, "or if anything else changes that you're concerned about."
A retrospective chart review study from a large tertiary pediatric center looked at 10 years of data. They wanted to know how many kids ended up developing pneumonia after an initially negative CXR.
Nearly 10,000 children were included, with only 240 (2.4%) returning for a repeat x-ray within 2 weeks of the index visit. Of these, only 27 developed pneumonia. That's 0.27%, or 1 in 370, of the nearly 10,000 that had a negative chest x-ray initially.
Factors found at the index visit that were associated with subsequent development of pneumonia were tachypnea, hypoxemia, and signs of dehydration. Of those who developed PNA after initially negative CXR, about half were admitted, and about 1/3 had symptoms for less than 3 days at the index visit.
Bottom Line: Development of pneumonia after a negative chest xray is quite rare (0.27% based on this relatively large study). Watch out for specific findings such as tachypnea, hypoxemia, and signs of dehydration. I think this also highlights the importance of REALLY GOOD RETURN PRECAUTIONS. Tell parents to come back if their child develops X, Y or Z, "or if anything else changes that you're concerned about."
