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Chest Radiography for Presumed Pneumonia in Children

Article Number: SIS380492AI050825
5th August, 2025
Author(s):
Julie R. Barzilay, Mark I. Neuman, Todd A. Florin
Abstract:

This interactive case discussion evaluates whether empirical antibiotics or chest radiography should guide treatment for a febrile 4-year-old with presumed pneumonia. Expert essays debate clinical judgment versus diagnostic imaging in outpatient pediatric settings. One perspective favors antibiotics based on clinical signs and epidemiologic data, citing radiography's limited influence on management decisions. The opposing view highlights the harms of unnecessary antibiotics and promotes radiography’s high negative predictive value. The piece underscores challenges in distinguishing bacterial from viral pneumonia and the importance of shared decision-making with caregivers.

Keywords:
pediatric pneumonia empirical antibiotics chest radiography diagnostic uncertainty pneumonia risk score febrile respiratory illness viral versus bacterial infection antibiotic stewardship parental anxiety outpatient management
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