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Background  Little is known about clinical factors associated with undetectable pneumonic shadows on chest radiographs ( CR s) for diagnosing pneumonia in the primary care setting.    Methods  A retrospective assessment of  CR s was conducted to compare chest computed tomography ( CT ) images of patients admitted to Kesennuma City Motoyoshi Municipal Hospital who were diagnosed with pneumonia from April 2014 to June 2016.    Results  Eighty‐three patients were included, and their average age was 83.8 years. Sixty‐eight patients (81.9%) were officially certified as requiring long‐term care or support. Twenty‐nine of the 83 patients (34.9%) had either negative or normal findings on  CR s, and positive findings consistent with pneumonia on  CT . There were no significant differences in gender, age, cardiothoracic ratio on  CR , or severity between the  CR ‐negative and  CR ‐positive groups. The proportion of negative  CR s was significantly higher in patients with certified care level 5 under the long‐term care system in Japan and tube feeding.    Conclusion  The failure rate of  CR s for detecting pneumonic shadows was significantly higher in patients with certified care level 5 and tube feeding.

Risk factors for detection failures of chest radiography in diagnosing pneumonia