RANDOMIZED CONTROLLED TRIAL OF CLINICAL OUTCOME AFTER CHEST RADIOGRAPH IN AMBULATORY ACUTE LOWER-RESPIRATORY INFECTION IN CHILDREN

Background When available, chest radiographs are used widely in acute lower-respiratory-tract infections in children. Their impact on clinic al outcome is unknown, Methods 522 children aged 2 to 59 months who me t the WHO case definition for pneumonia were randomly allocated to hav e a chest radiograph or not. The main outcome was time to recovery, me asured in a subset of 295 patients contactable by telephone. Subsidiar y outcomes included diagnosis, management, and subsequent use of healt h facilities, Findings; There was a marginal improvement in time to re covery which was not clinically significant. The median time to recove ry was 7 days in both groups (95% CI 6-8 days and 6-9 days in the radi ograph and control groups respectively, p=0.50, log-rank test) and the hazard ratio for recovery was 1.08 (95% CI 0.85-1.34), This lack of e ffect was not modified by clinicians' experience and no subgroups were identified in which the chest radiograph had an effect, Pneumonia and upper-respiratory infections were diagnosed more often and bronchioli tis less often in the radiograph group. Antibiotic use was higher in t he radiograph group (60.8% vs 52-2%, p=0.05). There was no difference in subsequent use of health facilities. Interpretation!on Chest radiog raph did not affect clinical outcome in outpatient children with acute lower-respiratory infection. This lack of effect is independent of cl inicians' experience, There are no clinically identifiable subgroups o f children within the WHO case definition of pneumonia who are likely to benefit from a chest radiograph. We conclude that routine use of ch est radiography is not beneficial in ambulatory children aged over 2 m onths with acute lower-respiratory-tract infection.