Throughout (Naoyuki Miyashita et al), from the Journal of

Throughout the article, “Detection Failure Rate of Chest Radiography for the Identification of Nursing and Healthcare-associated Pneumonia” (Naoyuki Miyashita et al), from the Journal of Infection and Chemotherapy, there is conflict as to whether a chest radiograph or CT scan would be better at diagnosing nursing and health-care associated pneumonia (NHCAP). Certain populations were assigned into groups in order to assess the success of a chest radiograph versus a CT scan in diagnosing pneumonia. It is important to keep in mind when reading this article, that it was conducted in Japan and the research method should be scrutinized. The importance of this study is that pneumonia is the third leading cause of mortality in Japan, with 97% being elderly. After conducting the study and reviewing the results, it can be concluded that CT is better at detecting NHCAP than a chest radiograph. However, this cannot be generalized to all patient populations, as it pertains mostly to an elderly population with mobility deficits and co-morbid conditions.  This study initially included 318 patients, however, only 208 of those were actually diagnosed with pneumonia-related lesions. From January 2013 to September 2014, patients who visited the Kawasaki Medical Center/Hospital and showed symptoms of pneumonia were included in the study. The participants were divided into 4 groups; A) Residents of a nursing home, B) Residents discharged from the hospital within 90 days, C) Elderly or disabled receiving nursing care and have limited to no mobility, and D) Persons receiving regular treatment as an outpatient. All of these patients, regardless of their group, have been diagnosed with pneumonia. In addition to these groupings, the pneumonia was also classified into one of four categories; mild, moderate, severe, and very severe. “Among the pneumonia severity groups, chest radiography identified pneumonia cases significantly less often than HRCT in the moderate group” (Miyashita et al). More specifically, aspiration pneumonia is thought to be the most frequent cause of NHCAP. A variety of speech tests were conducted to confirm a swallowing dysfunction, such as dysphagia. “Usually, chest radiography is the first imaging technique utilized for the evaluation of acute respiratory symptoms, and this method is still recommended as the standard reference method for confirming the diagnosis of pneumonia” (Miyahshita et al). If an abnormal shadow is not identified, this can lead to misdiagnosis and thus, fatal consequences. For this study, however, both chest radiography and chest CT scans were used in order to compare results. For the chest radiograph, a postero-anterior view was utilized and for the chest CT scan, the patient was in supine position, both suspended breathing at the end of inspiration.  Within a few days of examination, two radiologists, with each over 20 years of experience, reviewed the images. There was found to be greater inter-rater reliability when assessing a chest radiograph than a CT. For groups A and C, a chest radiograph had a lower detection rate than CT. The majority of the population in these two groups were elderly with limited mobility. This is important to the study, since there may be a correlation between insufficient mobility and functioning and the low detection rate of pneumonia in chest radiographs. On the other hand, groups B and D showed a better detection rate for a chest radiograph than CT. However, this was generally a younger population with adequate mobility and functioning status. Nonetheless, the detection rate for each modality is thought to be depended on the age group and functional status of the individual


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