Soudack Michalle, Plotkin Semion, Ben-Shlush Aviva, Raviv-Zilka Lisa, Jacobson Jeffrey M, Benacon Michael, Augarten Arie
Department of Pediatric Imaging, Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Isr Med Assoc J. 2018 Jan;20(1):5-8.
Opinions differ as to the need of a lateral radiograph for diagnosing community acquired pneumonia in children referred to the emergency department. A lateral radiograph increases the ionizing radiation burden but at the same time may improve specificity and sensitivity in this population.
To determine the value of the frontal and lateral chest radiographs compared to frontal view stand-alone images for the management of children with suspected community acquired pneumonia seen in a pediatric emergency department.
Chest radiographs from 451 children with clinically suspected pneumonia were retrospectively reviewed. Interpretation of frontal views was compared to interpretation of combined frontal and lateral view, the latter being the gold standard.
Findings consistent with bacterial pneumonia were diagnosed in 94 (20.8%) of the frontal stand-alone radiographs and in 109 (24.2%) of the combined frontal and lateral radiographs. The sensitivity, specificity, positive predictive value, and negative predictive value of the frontal radiograph alone were 86.2%, 93.9%, 81.7%, and 95.5%, respectively. False positive and false negative rates were 15% and 21%, respectively, for the frontal view alone. The number of lateral radiographs needed to diagnose one community acquired pneumonia was 29.
The lateral chest radiograph improves the diagnosis of pediatric community acquired pneumonia to a certain degree and may prevent overtreatment with antibiotics.
对于在急诊科就诊的疑似社区获得性肺炎的儿童，是否需要拍摄侧位胸片存在不同观点。侧位胸片会增加电离辐射负担，但同时可能提高该人群诊断的特异性和敏感性。
确定与单独的正位胸片相比，正位和侧位胸片联合用于儿科急诊科疑似社区获得性肺炎儿童的管理的价值。
回顾性分析451例临床疑似肺炎儿童的胸片。将单独正位胸片的解读与正位和侧位联合胸片的解读进行比较，后者为金标准。
单独正位胸片诊断出94例（20.8%）符合细菌性肺炎的病例，正位和侧位联合胸片诊断出109例（24.2%）。单独正位胸片的敏感性、特异性、阳性预测值和阴性预测值分别为86.2%、93.9%、81.7%和95.5%。单独正位胸片的假阳性率和假阴性率分别为15%和21%。诊断一例社区获得性肺炎所需的侧位胸片数量为29张。
侧位胸片在一定程度上可改善儿科社区获得性肺炎的诊断，并可能避免抗生素的过度使用。
