The inter-observer variation of chest radiograph reading in acute lower respiratory tract infection among children.

This study assessed the inter-observer agreement in the interpretation of several radiographic features in the chest radiographs (CXR) of 803 children aged 2-59 months with non-severe acute lower respiratory tract infection (ALRI). Inclusion criteria comprised: report of respiratory complaints, detection of lower respiratory findings, and presence of pulmonary infiltrate on the CXR taken on admission and read by the pediatrician on duty. Data on demographic and clinical findings on admission were collected from children included in a clinical trial on the use of amoxicillin (ClinicalTrials.gov Identifier NCT01200706). CXR was later read by two independent pediatric radiologists blinded to clinical information and pneumonia was finally diagnosed if there was agreement on the presence of pulmonary infiltrate or pleural effusion. The kappa index (κ) of agreement was calculated. The radiologists agreed that 774 (96.4%) and 3 (0.4%) CXR were appropriate or inappropriate for reading, respectively, and that 222 (28.7%) and 459 (59.3%) CXR presented or did not present pneumonia. In intent to treat analysis, that is, considering the 803 enrolled patients, κ for the presence of pneumonia was 0.725 (95% CI: 0.675-0.775). The overall agreement was 78.7% (normal CXR [n = 385, 60.9%], pneumonia [n = 222, 35.1%], other radiological diagnosis [n = 22, 3.5%], inappropriate for reading [n = 3, 0.5%]). The most frequent radiological findings were alveolar infiltrate (33.2%) and consolidation (32.9%) by radiologist 1 and consolidation (28.3%) and alveolar infiltrate (19.3%) by radiologist 2. Concordance for consolidation was 86.7% (k = 0.683, 95%CI: 0.631-0.741). Agreement was good between two pediatric radiologists when diagnosis of pneumonia among children with non-severe ALRI was compared.

Clinical failure among children with nonsevere community-acquired pneumonia treated with amoxicillin.

OBJECTIVE: To estimate the clinical failure and adverse events in children with nonsevere pneumonia receiving amoxicillin, identifying risk factors. RESEARCH DESIGN/METHODS: 192 patients aged 2 - 59 months were prospectively followed up. Pneumonia diagnosis was based on respiratory complaints and radiographic pulmonary infiltrate or pleural effusion. Amoxicillin (50 mg/kg/day) was given. Demographic data and clinical findings on admission, daily evolution up to the 5th day of treatment and 2 - 4 weeks after enrollment were collected. MAIN OUTCOME MEASURES: Clinical failure included persistence of fever, difficulty breathing or tachypnea beyond the first 48 h of treatment or of cough beyond the first 96 h of treatment or sign of severe/very severe disease up to the 5th day of treatment. RESULTS: Amoxicillin failed in 6 (3.1%) cases. By excluding one child diagnosed with cystic fibrosis after continued follow-up, the final clinical failure rate was 2.6%. The total adverse effect frequency was 14 (7.3%), but amoxicillin was discontinued only in 1 (0.5%) case. No relapse was identified at the 2 - 4-week interval evaluation. By multivariate analysis, age (OR = 1.1; 95% CI 1.01 - 1.19) was an independent risk factor for clinical failure which occurred in older children (47 +/- 9 vs 31 +/- 16 months; p = 0.01). CONCLUSIONS: Clinical failures were few, especially among those aged < 2 years. Amoxicillin discontinuation due to adverse reaction was rare.