PURPOSE OF THE STUDY.
To identify patient factors associated with ordering of chest radiograph (CXR) in children hospitalized with acute asthma exacerbations and those patient factors associated with a positive CXR result.
The study included children between 2 and 19 years of age admitted from the pediatric emergency department (ED) at a children’s hospital in Alabama with a primary diagnosis of acute asthma exacerbation or status asthmaticus. The mean age of patients was 6.8 ± 0.4 years.
The patients were retrospectively identified through chart review from June 2011 to May 2012. Patients were excluded if they did not have any details of the ED visit in their chart, were already taking antibiotics before the ED visit, received continuous albuterol or intravenous magnesium during the ED visit or inpatient stay, or had another chronic disease affecting lung function.
Of the 405 patients included in the study, 40% (180 patients) had CXR performed, and 74% of these were ordered in the ED. Of the 180 patients who had CXR performed, 10% (18 patients) had positive CXR results. Nine patients had a diagnosis of atelectasis versus infiltrate, 6 patients had radiographic pneumonia, and 3 patients had pneumomediastinum and/or pneumothorax. Eleven of the 15 patients with equivocal infiltrative CXR or radiographic pneumonia were started on antibiotics in the ED. Patient factors that influenced an ED physician to order a CXR were ≤ 4 years of age, fever in either the ED or at home, and triage oxygen saturation ≤92% on room air (P < .05 for all). Patient factors associated with a positive CXR were ED temperature of ≥38.4°C (P < .05) and triage oxygen saturation ≤92% on room air (P < .01). Age and history of fever were not significantly associated with positive CXR.
The yield of CXRs for asthma patients requiring noncritical inpatient care is low and that the majority of these CXRs do not provide treatment-altering information.
This study highlights that current CXR ordering habits in noncritical asthmatic patients may be unnecessary in the ED setting. There were patient factors associated with positive CXR findings, suggesting that development of uniform criteria to order a CXR and to start antibiotics in these patients may be useful. CXR evaluation of asthmatics in the emergent setting does not appear to offer any benefit and carries the risk of radiation exposure. Clinicians in both the ED and primary care settings should reconsider the frequency of CXR use in the pediatric asthma population.
- Copyright © 2015 by the American Academy of Pediatrics