Diagnostic Value of Chest Radiographs in Bedridden Patients Suspected of Having Pneumonia

• Published in: The American journal of medicine Vol. 123; no. 1; pp. 88.e1 - 88.e5
• Main Authors: Esayag, Yaacov, MD, Nikitin, Irina, MD, Bar-Ziv, Jacob, MD, Cytter, Ruth, MD, Hadas-Halpern, Irith, MD, Zalut, Todd, MD, Yinnon, Amos M., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 2010
• Subjects: Adolescent; Adult; Age Distribution; Aged; Aged, 80 and over; Bed Rest - adverse effects; Bedridden; Chest computed tomography; Chest radiograph; Female; Follow-Up Studies; Hospitals, University; Humans; Incidence; Inpatients; Internal Medicine; Male; Middle Aged; Pneumonia; Pneumonia - diagnostic imaging; Pneumonia - epidemiology; Pneumonia - etiology; Predictive values; Probability; Prospective Studies; Radiography, Thoracic - methods; Risk Assessment; Sensitivity; Sex Distribution; Tomography, X-Ray Computed - methods; Young Adult; Chest radiograph; Bedridden; Pneumonia; Sensitivity; Chest computed tomography; Predictive values
• ISSN: 0002-9343; 1555-7162
• DOI: 10.1016/j.amjmed.2009.09.012

Abstract Objectives To assess the diagnostic value of the chest radiograph for the diagnosis of pneumonia in bedridden patients, using non-contrast-enhanced high-resolution chest computed tomography (CT) as the gold standard. Methods We prospectively evaluated bedridden patients hospitalized with moderate to high clinical probability of pneumonia. Chest radiographs were interpreted in a blinded fashion by 3 observers and classified as definite, normal, or uncertain for pneumonia. Chest CT was obtained within 12 hours of chest radiograph. We applied Bayesian analysis to assess the accuracy of chest radiograph in the diagnosis of pneumonia. Results In a 5-month period, 58 patients were evaluated, 31 (53%) were female. Their chest radiographs were interpreted as negative, uncertain, or positive for pneumonia in 31 (53%), 15 (26%), and 12 (21%) patients, respectively, while CT confirmed pneumonia in 11 (35%), 10 (67%), and in 10 (83%). The sensitivity of the chest radiograph to diagnose pneumonia was 65%, the specificity was 93%, the positive and negative predictive values were, respectively, 83% and 65%, while the overall accuracy was 69% (95% confidence interval, 50%-79%). Conclusions In bedridden patients with suspected pneumonia, a normal chest radiograph does not rule out the diagnosis, hence, a chest CT scan might provide valuable diagnostic information.