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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The use of chest radiograph as an adjunct method for the diagnosis of pediatric community-acquired pneumonia &#40;CAP&#41; has been highly debated over the past decades&#46; So far&#44; current evidence has demonstrated that specific radiological findings cannot be reliably used for the etiological diagnosis of CAP&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1&#44;2</span></a> Nevertheless&#44; in our study&#44; we demonstrated that the presence of a normal chest radiograph has a high negative predictive value for infection by <span class="elsevierStyleItalic">Streptococcus pneumoniae</span>&#44; the most common typical bacterial agent of CAP&#46; As viral agents are the most common etiologic agents of pediatric CAP&#44; this finding may aid in the clinical management of children with signs and symptoms of CAP by selecting those who might benefit from empiric antibiotic therapy&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Standardized protocols for the evaluation of the chest radiograph are useful in the interpretation of this exam&#46; In our study&#44; we used the recommended criteria defined by the World Health Organization&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">3&#44;4</span></a> However&#44; alternative scales have been described and partially validated for clinical practice&#46; Heinsohn has mentioned the Khamapirad scale&#44;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> which is a grading system based on radiologic characteristics such as the presence&#44; type and location of pulmonary infiltrates&#44; pleural effusion&#44; abscesses and atelectasis&#46; Although high sensitivity and specificity have been described for the use of this scale&#44;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> it is important to note that further validation in a clinical setting is required&#44; including the use of reliable and sensitive techniques for the etiologic diagnosis of bacterial and viral agents of CAP&#46; Nevertheless&#44; the recognition of radiological patterns&#44; particularly the normal chest radiograph&#44; as a tool for the management of pediatric CAP is valid and merits further investigation&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">In conclusion&#44; chest radiographs provide indirect evidence of etiologic agents of CAP&#46; Radiologic scales or grading systems that aid in the differentiation between a normal chest radiograph and radiological pneumonia may be a useful tool for the management of pediatric CAP cases but should be adequately validated before inclusion in the clinical practice&#46;</p><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0110" class="elsevierStylePara elsevierViewall">The authors declare no conflicts of interest&#46;</p></span></span>"
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Letter to the Editor
Radiologic scales as a tool for the etiologic diagnosis of pediatric community-acquired pneumonia
Escalas radiológicas como uma ferramenta para o diagnóstico etiológico de pneumonia adquirida na comunidade pediátrica
Dafne C. Andrade
Corresponding author
andradedafne@yahoo.com.br

Corresponding author.
, Cristiana Maria Nascimento-Carvalho
Universidade Federal da Bahia, Faculdade de Medicina, Programa de Pós-graduação em Ciências da Saúde, Salvador, BA, Brazil
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The use of chest radiograph as an adjunct method for the diagnosis of pediatric community-acquired pneumonia &#40;CAP&#41; has been highly debated over the past decades&#46; So far&#44; current evidence has demonstrated that specific radiological findings cannot be reliably used for the etiological diagnosis of CAP&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1&#44;2</span></a> Nevertheless&#44; in our study&#44; we demonstrated that the presence of a normal chest radiograph has a high negative predictive value for infection by <span class="elsevierStyleItalic">Streptococcus pneumoniae</span>&#44; the most common typical bacterial agent of CAP&#46; As viral agents are the most common etiologic agents of pediatric CAP&#44; this finding may aid in the clinical management of children with signs and symptoms of CAP by selecting those who might benefit from empiric antibiotic therapy&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Standardized protocols for the evaluation of the chest radiograph are useful in the interpretation of this exam&#46; In our study&#44; we used the recommended criteria defined by the World Health Organization&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">3&#44;4</span></a> However&#44; alternative scales have been described and partially validated for clinical practice&#46; Heinsohn has mentioned the Khamapirad scale&#44;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> which is a grading system based on radiologic characteristics such as the presence&#44; type and location of pulmonary infiltrates&#44; pleural effusion&#44; abscesses and atelectasis&#46; Although high sensitivity and specificity have been described for the use of this scale&#44;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> it is important to note that further validation in a clinical setting is required&#44; including the use of reliable and sensitive techniques for the etiologic diagnosis of bacterial and viral agents of CAP&#46; Nevertheless&#44; the recognition of radiological patterns&#44; particularly the normal chest radiograph&#44; as a tool for the management of pediatric CAP is valid and merits further investigation&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">In conclusion&#44; chest radiographs provide indirect evidence of etiologic agents of CAP&#46; Radiologic scales or grading systems that aid in the differentiation between a normal chest radiograph and radiological pneumonia may be a useful tool for the management of pediatric CAP cases but should be adequately validated before inclusion in the clinical practice&#46;</p><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0110" class="elsevierStylePara elsevierViewall">The authors declare no conflicts of interest&#46;</p></span></span>"
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Article information
ISSN: 00217557
Original language: English
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