Should the lateral chest radiograph be a routine examination in the diagnosis of pneumonia in children?

Background: Chest X-rays are frequently used in the diagnosis of pneumonia in children.1 The lateral examination produces more than double the effective patient dose of the frontal examination and is associated with a higher repeat rate.2

Objective: To investigate whether the lateral chest X-ray is necessary for the routine diagnosis of pneumonia in children.

Methods: Four databases (MedLine, PubMED, Cochrane and Scopus) were searched. Studies meeting the selection criteria were appraised by two reviewers using NHMRC guidelines and QUADAS-2 tool.3

Results: Two retrospective studies and one random control trial were identified from the search. Despite the small body of evidence, the results were considered low risk, highly applicable and of high quality (Grade B Recommendation).3

Discussion: All the studies agreed that the combined frontal and lateral examinations was able to diagnose more pneumonias than the frontal only examination. However, there seems to be disagreement as to whether the amount is significant. One study assessed the impact on the clinical environment found that having the frontal examination only did not significantly change the clinical management of the patients in comparison to both examinations. No studies looked at the efficiency or costs associated with the lateral examination.

Conclusion: While the lateral chest X-ray is important for characterising certain pathologies and may be useful for further investigation of some abnormal images, it should not be used routinely. More research is required to determine the clinical impact of the lateral chest X-ray on the diagnosis of pneumonia in children.