Relevance of chest radiography in pediatric inpatients with asthma

Abstract

Introduction: The goals of this study are to identify factors associated with ordering of chest radiographs (CXR’s) in children hospitalized with acute asthma exacerbations and determine the overall clinical impact of these CXR’s. Methods: A retrospective study was performed with children ≥ 2 years of age admitted from our emergency department (ED) between 6/1/2011 and 5/31/2012 with a primary diagnosis of acute asthma exacerbation or status asthmaticus. Patients were excluded if they had been on antibiotics prior to the emergency visit, received continuous albuterol or intravenous magnesium during the hospitalization, or had another chronic disease affecting lung function. Results: 180 of the 405 children in the study (44%) had CXR’s ordered, of which 18 (10%) had imaging that altered the patient’s treatment plan. There were six cases of radiologist-diagnosed pneumonia, nine cases of atelectasis treated with antibiotics and three cases of pneumothorax. Factors associated with CXR ordering were: fever at home or in the ED (OR 4.5, 95% CI 2.8–7.4), triage oxygen saturation less than or equal to 92% (OR 1.8, 95% CI 1.2–2.7) and age 4 years or less (OR 2.3, 95% CI 1.4–3.7). Patients with treatment-altering CXR’s were more likely to have oxygen saturations less than or equal to 92% (OR 4.2, 95% CI 1.4–13.0; p = 0.006) or fever in the ED (OR 3.8, 95% CI 1.0–13.6; p < 0.05). No patients with triage oxygen saturation above 96% had a treatment-altering CXR. Conclusions: The majority of CXR’s ordered in pediatric inpatients with asthma exacerbation do not provide clinically relevant information.

• Diagnostics
• epidemiology
• pediatrics

Contributions

Dr. Narayanan conceived and designed this study, analyzed and interpreted data, drafted the article, and gave final approval of the version to be published.

Dr. Magruder made contributions to study conception and design, interpretation of data, and revised the article for intellectual content.

Dr. Walley made contributions to study conception and design, and revised the article for intellectual content.

Mr. Powers acquired data for the study and made contributions to analysis and interpretation of the data.

Dr. Wall made contributions to study conception and design, acquisition of data, revised the article for intellectual content, and contributed to final approval of the version to be published.