Telemedicine and Utilization of Chest X-Rays in Pediatric Community-Acquired Pneumonia: Lessons from the COVID-19 Lockdown

Community-acquired pneumonia (CAP) is a leading infectious disease in children, with management guidelines emphasizing clinical judgment over routine imaging. The COVID-19 pandemic accelerated telehealth adoption, raising questions about its impact on pediatric CAP care. We conducted a retrospective database study within primary care, comparing chest X-ray use for CAP diagnosis during three lockdown periods (2020-2021) with corresponding pre-pandemic periods (2018-2019). Children aged 1-14 years with CAP diagnoses were included (<i>n</i> = 3,499 pre-pandemic; <i>n</i> = 438 during lockdown). Remote consultations increased significantly (1.7% vs. 11.6%, <i>p</i> < 0.001), while chest X-ray referrals remained stable, and antibiotic use also stayed consistent. Predictors for imaging shifted: pre-pandemic, older age and longer travel distance were significant factors, whereas during lockdown, only higher socioeconomic status was associated. The ongoing use of telemedicine after COVID-19 offers an opportunity to develop strategies that improve diagnostic confidence and encourage "choosing wisely" in pediatric pneumonia diagnosis.