Chest Radiograph Utilization Among Children Treated for Pneumonia in a Primary Care Network

This retrospective cohort study across 77 pediatric practices in Massachusetts assessed the frequency of CXR utilization among children with pneumonia diagnosed in the primary care setting and determined whether CXR utilization was associated with differences in antibiotic treatment and outcomes. Multivariable logistic regression was used to evaluate the association between CXR performance and future clinic revisit, CXR performance, antibiotic change, and a composite treatment failure outcome, adjusting for markers of illness severity. Among 29 528 children treated for pneumonia, 2462 (10.1%) had a CXR performed. CXR utilization varied by practice (range 0%-75% [IQR 2.7%-16.5%]). The odds of a composite outcome of treatment failure did not differ between children who had a CXR performed and those who did not (aOR 1.06; 95% CI [0.68, 1.65]). CXR was performed in the minority of patients diagnosed with pneumonia. Children who had a CXR performed had similar outcomes to those treated for pneumonia without CXR.