Chest Radiograph in the Pediatric Inpatient: A chart review

Objective: To determine the usefulness of the chest radiograph in reaching a clinical diagnosis in the pediatric inpatient population at a tertiary care centre in Karachi, Pakistan. Methodology: This was a retrospective chart review of pediatric inpatients (1 month -14 years) at Aga Khan Hospital, Karachi between April and June 2009. Radiographs ordered to assist diagnosis of disease, or as ‘routine’, were selected samples (n=326). For each radiograph, the clinical indication, the radiological diagnosis and the final clinical diagnosis were recorded and analyzed for frequencies and by cross-tabulation for concurrence. Results: The largest proportion of the clinical indications was the routine chest x-ray, at 39.3%. The most common diagnosis in radiology reports was ‘no chest pathology’ (39.9%). The second most common was ‘pulmonary infection’. Almost 46.3% of the patients who had chest x-rays had no chest pathology in the clinical diagnosis. The greatest concurrence was found between the clinical indication ‘fever and cough’ with a radiological and clinical diagnosis of pulmonary infection (62.3% and 49.1% respectively). Conclusions: A significant proportion of the radiographs ordered for pediatric inpatients were normal and not associated with chest pathology on clinical diagnosis. Strong clinical suspicion of pulmonary infection, denoted by fever and cough, had the highest likelihood of giving the same radiological and clinical diagnosis.