Role of chest x-ray in diagnosis of lower respiratory tract infections in children less than five years of age in community.

Objectives: To compare radiological findings of chest radiograph with the diagnosis of pneumonias in children as per IMCI guidelines and; see its utility in community setting and; compare the variance in their reporting between trained pediatric radiologist and treating pediatrician. Setting: Four periurban communities in Karachi were selected for study. Methods: Children presenting with cough and fever at especially established clinics were investigated with oro-pharyngeal swabs, blood culture and chest radiograph. Results: 6383 children were seen with acute respiratory infection during January 2002 to February 2003. Of these 1203 children had pneumonia and severe pneumonia. Chest radiographs were obtained in 823 children. Only 45 % of these radiographs had signs suggestive of infection. There was no significant difference of opinion between radiologist and pediatrician in reports of those radiographs having signs suggestive of infection. However 19 % of all radiographs were reported as non-interpretable for any meaningful interpretation due to poor quality of film by pediatrician but majority of these radiographs were considered within normal limit by radiologist. There was no correlation between reports of radiographs and isolation of organisms from oro-pharyngeal swabs. Nearly half of children with pneumonia and those who grew organisms from oro-pharyngeal swabs had normal chest radiographs. Conclusion: Chest radiographs have little value in diagnosis of pneumonia in children less than five years of age and; no significant difference of opinion between pediatrician and radiologist was found in interpretation of radiographs.