P NEG CXR IN ED

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A recent study titled "Risk of Subsequent Pneumonia After a Negative Chest Radiograph in the ED" by Hirsch et al., published in Pediatrics in April 2025, investigates the likelihood of children developing pneumonia after an initial negative chest X-ray (CXR) in the emergency department (ED). citeturn0search0

Study Overview:

• Objective: To determine the percentage of children who develop radiographic pneumonia after an initially normal CXR and to describe the clinical characteristics of these cases.

• Methodology: The study prospectively enrolled children aged 3 months to 18 years who underwent CXRs for suspected pneumonia in a tertiary-care pediatric ED. Exclusions included children currently on antibiotics and those with underlying chronic medical conditions. CXR results were categorized as positive, equivocal, or negative based on radiologist interpretation. Children with negative CXRs and without a clinical diagnosis of pneumonia were observed for two weeks post-ED visit.

Key Findings:

• Out of 683 children enrolled, 457 (72.8%) had negative CXRs. Among these, 44 children (8.9%) were clinically diagnosed with pneumonia at the time of the ED visit despite the negative CXR.

• Of the 411 children with negative CXRs who were managed without antibiotics, only 5 were subsequently diagnosed with pneumonia within two weeks, yielding a negative predictive value of 98.8% (95% confidence interval: 97.0%-99.6%).

Conclusions:

The study concludes that a negative CXR effectively excludes pneumonia in the majority of pediatric cases. Children with negative CXRs and low clinical suspicion for pneumonia can be safely observed without the immediate initiation of antibiotic therapy. citeturn0search0

Clinical Implications:

These findings support the practice of withholding antibiotics in pediatric patients who present with respiratory symptoms but have negative CXR results and low clinical suspicion for pneumonia, thereby reducing unnecessary antibiotic use and its associated risks.