Evaluation of the World Health Organization criteria for chest radiographs for pneumonia diagnosis in children

Abstract

The WHO guidelines for interpretation of chest radiographs result in high level of agreement between readers for the definition of "alveolar pneumonia" and "no pneumonia" but poor agreement for non-alveolar pneumonia. The disagreement with regard to the latter was associated with overdiagnosis by pediatricians, which may lead to overtreatment. We believe that radiographic non-alveolar pneumonia should not be an endpoint for clinical trials and research, nor should it be implemented in clinical setting.

Accuracy of the Interpretation of Chest Radiographs for the Diagnosis of Paediatric Pneumonia

“…It has been recently shown among a group of 13 paediatricians and two radiologists that the main variability related to non-end-point changes [24]. Therefore the impact of heterogeneity on explaining this observed substantial reporting variability in our study is less likely.…”

Impact of PCV7/PCV13 introduction on community-acquired alveolar pneumonia in children <5 years

“…However, we used the WHO chest radiograph definition as it has been used in many studies evaluating various PCVs efficacy and effectiveness. Additionally, it was demonstrated that this definition has a good correlation among observers and can be used to compare results in a study with more than one investigator [39]. The chest radiograph process used in this study (pediatricians and pediatric radiologist) was similar to the one recommended by the WHO working group [10].…”

Association Between Bacterial Infection and Radiologically Confirmed Pneumonia Among Children

“…1 However, the standard to diagnose CaP is lacking. 2 By definition, CaP is the result of inflammation of the terminal airways (the alveoli) due to the presence of an infectious agent acquired in the community. 3 as a consequence, fluid and blood cells pass out of the blood into the alveoli and occupy the pulmonary space, which is normally filled with air.…”