Objectives: To evaluate the chest radiographs of children diagnosed with non-severe pneumonia on the basis of the current World Health Organization guidelines (fast breathing alone) for radiological evidence of pneumonia.
Design: Descriptive analysis.
Setting: Outpatient departments of six hospitals in four cities in Pakistan.
Participants: 2000 children with non-severe pneumonia were enrolled; 1932 children were selected for chest radiography.
Interventions: Two consultant radiologists used standardised WHO definitions to evaluate chest radiographs; no clinical information was made available to them. If they disagreed, the radiographs were read by a third radiologist; the final classification was based on agreement between two of the three radiologists.
Main outcome measures: Presence or absence of pneumonia on radiographs.
Results: Chest radiographs were reported normal in 1519 children (82%). Radiological evidence of pneumonia was reported in only 263 (14%) children, most of whom had interstitial pneumonitis. Lobar consolidation was present in only 26 children. The duration of illness did not correlate significantly with the presence of radiological changes (relative risk 1.17, 95% confidence interval 0.91 to 1.49).
Conclusion: Most children diagnosed with non-severe pneumonia on the basis of the current WHO definition had normal chest radiographs.