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American Academy of Pediatrics
Article

Variation and Trends in ED Use of Radiographs for Asthma, Bronchiolitis, and Croup in Children

Jane F. Knapp, Stephen D. Simon and Vidya Sharma
Pediatrics July 2013, peds.2012-2830; DOI: https://doi.org/10.1542/peds.2012-2830
Jane F. Knapp
aDepartment of Pediatrics, Children’s Mercy Hospitals and Clinics, and
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Stephen D. Simon
bDepartment of Biomedical and Health Informatics, University of Missouri–Kansas City, School of Medicine, Kansas City, Missouri
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Vidya Sharma
aDepartment of Pediatrics, Children’s Mercy Hospitals and Clinics, and
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Abstract

OBJECTIVES: The objectives were (1) to determine trends in radiograph use in emergency department (ED) care of children with asthma, bronchiolitis, and croup; and (2) to examine the association of patient and hospital factors with variation in radiograph use.

METHODS: A retrospective, cross-sectional study of National Hospital Ambulatory Medical Care Survey data between 1995 and 2009 on radiograph use at ED visits in children aged 2 to 18 years with asthma, aged 3 months to 1 year with bronchiolitis, and aged 3 months to 6 years with croup. Odds ratios (ORs) were calculated and adjusted for all factors studied.

RESULTS: The use of radiographs for asthma increased significantly over time (OR: 1.06; 95% confidence interval [CI]: 1.03–1.09; P < .001 for trend) but were unchanged for bronchiolitis and croup. Pediatric-focused EDs had lower use for asthma (OR: 0.44; 95% CI: 0.29–0.68), bronchiolitis (OR: 0.37; 95% CI: 0.23–0.59), and croup (OR: 0.34; 95% CI: 0.17–0.68). Compared with the Northeast region, the Midwest and South had statistically higher use of radiographs for all 3 conditions. The Western region had higher use only for asthma (OR: 1.67; 95% CI: 1.07–2.60), and bronchiolitis (OR: 2.94; 95% CI: 1.48–5.87). No associations were seen for metropolitan statistical area or hospital ownership status.

CONCLUSIONS: The ED use of radiographs for children with asthma increased significantly from 1995 to 2009. Reversing this trend could result in substantial cost savings and reduced radiation. Pediatric-focused EDs used significantly fewer radiographs for asthma, bronchiolitis, and croup. The translation of practices from pediatric-focused EDs to all EDs could improve performance.

  • emergency department
  • asthma
  • bronchiolitis
  • croup
  • quality
  • performance indicators
  • measures
  • trends
  • variation
  • pediatric
  • radiograph
  • Abbreviations:
    CI —
    confidence interval
    ED —
    emergency department
    ICD-9-CM —
    International Classification of Diseases, Ninth Revision, Clinical Modification
    NHAMCS —
    National Hospital Ambulatory Medical Care Survey
    OR —
    odds ratio
    • Accepted April 29, 2013.
    • Copyright © 2013 by the American Academy of Pediatrics

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    Pediatrics
    Vol. 147, Issue 2
    1 Feb 2021
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    Variation and Trends in ED Use of Radiographs for Asthma, Bronchiolitis, and Croup in Children
    Jane F. Knapp, Stephen D. Simon, Vidya Sharma
    Pediatrics Jul 2013, peds.2012-2830; DOI: 10.1542/peds.2012-2830

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    Variation and Trends in ED Use of Radiographs for Asthma, Bronchiolitis, and Croup in Children
    Jane F. Knapp, Stephen D. Simon, Vidya Sharma
    Pediatrics Jul 2013, peds.2012-2830; DOI: 10.1542/peds.2012-2830
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    Subjects

    • Radiology
      • Radiology
    • Emergency Medicine
      • Emergency Medicine

    Keywords

    • emergency department
    • asthma
    • bronchiolitis
    • croup
    • quality
    • performance indicators
    • measures
    • trends
    • variation
    • pediatric
    • radiograph
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