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

Esayag, Yaacov; Nikitin, Irina; Bar-Ziv, Jacob; Cytter, Ruth; Hadas-Halpern, Irith; Zalut, Todd; Yinnon, Amos M.

doi:10.1016/j.amjmed.2009.09.012

« Previous Next »The American Journal of Medicine
Volume 123, Issue 1 , Pages 88.e1-88.e5, January 2010

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

Yaacov Esayag, MD
- Department of Internal Medicine, Shaare Zedek Medical Center, affiliated with the Hebrew University-Hadassah Medical School, Jerusalem, Israel
Irina Nikitin, MD
- Department of Diagnostic Radiology, Shaare Zedek Medical Center, affiliated with the Hebrew University-Hadassah Medical School, Jerusalem, Israel
Jacob Bar-Ziv, MD
- Department of Diagnostic Radiology, Shaare Zedek Medical Center, affiliated with the Hebrew University-Hadassah Medical School, Jerusalem, Israel
Ruth Cytter, MD
- Department of Diagnostic Radiology, Shaare Zedek Medical Center, affiliated with the Hebrew University-Hadassah Medical School, Jerusalem, Israel
Irith Hadas-Halpern, MD
- Department of Diagnostic Radiology, Shaare Zedek Medical Center, affiliated with the Hebrew University-Hadassah Medical School, Jerusalem, Israel
Todd Zalut, MD
- Department of Emergency Medicine, Shaare Zedek Medical Center, affiliated with the Hebrew University-Hadassah Medical School, Jerusalem, Israel
Amos M. Yinnon, MD
- Department of Internal Medicine, Shaare Zedek Medical Center, affiliated with the Hebrew University-Hadassah Medical School, Jerusalem, Israel
- Infectious Disease Unit, Shaare Zedek Medical Center, affiliated with the Hebrew University-Hadassah Medical School, Jerusalem, Israel
- Requests for reprints should be addressed to Amos M. Yinnon, MD, Division of Internal Medicine, Shaare Zedek Medical Center, P.O. Box 3235, Jerusalem 91031, Israel

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.

Keywords: Bedridden, Chest computed tomography, Chest radiograph, Pneumonia, Predictive values, Sensitivity