Predictors of a normal chest x-ray in respiratory syncytial virus infection

M C Kneyber, K G Moons, R de Groot, H A Moll

Research output: Contribution to journalArticleAcademicpeer-review

10 Citations (Scopus)


Respiratory syncytial virus (RSV) accounts for the majority of lower respiratory tract infections (LRTI) in infants and young children. A chest x-ray is frequently performed in infants with LRTI caused by RSV. The aim of this study was to develop and validate a prediction model to estimate the probability for a normal chest x-ray in children with RSV infection. For this purpose, easy obtainable diagnostic parameters were used. This prediction model may be applied to decide which patients do not require a chest x-ray. The data of 287 children admitted with RSV infection or diagnosed as such in the outpatient department of the Sophia Children's Hospital between 1992-1996 were studied. The derivation set comprised 232 patients (1992-1995), and the validation set contained 55 patients (1995-1996). A chest x-ray was designated as normal when atelectasis, hyperinflation, or pulmonary infiltrates were absent. In order to develop a prediction model, patient history and clinical and laboratory variables were consecutively entered into a logistic regression model according to the diagnostic workup that was practiced at the time. Variables with P < or = 0.10 were retained in the model. The predictive accuracy of the multivariable models was examined using the area under receiver operating curve (ROC-area). In 202 (87%) patients from the derivation set, a chest x-ray was performed. A normal chest x-ray could be predicted by increasing age, increasing birth weight, presence of rhinitis, absence of retractions, and increasing arterial oxygen saturation. The ROC-area was 0.80 in the derivation and validation sets. This prediction model was transformed into a score chart. In conclusion, a normal chest x-ray can accurately be predicted, using a model including easily obtainable patient characteristics, and clinical and laboratory variables. This model may be a useful tool in deciding whether or not to perform a chest x-ray in patients with RSV infections.

Original languageEnglish
Pages (from-to)277-283
Number of pages7
JournalPediatric Pulmonology
Issue number4
Publication statusPublished - Apr-2001


  • Diagnosis, Differential
  • False Negative Reactions
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Models, Theoretical
  • Predictive Value of Tests
  • Pulmonary Atelectasis/etiology
  • Radiography, Thoracic
  • Reference Values
  • Respiratory Syncytial Virus Infections/diagnostic imaging
  • Sensitivity and Specificity

Cite this