ED chest radiography for children with asthma exacerbation is infrequently associated with change of management

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Evan H Allie1, Henry E Dingle2, William N Johnson3

  • 1Pediatric Emergency Medicine, Vanderbilt University Medical Center, Monroe Carell Jr. Childrens' Hospital, Nashville, TN, United States.

The American Journal of Emergency Medicine
|November 16, 2017
PubMed

Insights

Chest X-rays (CXRs) rarely provide useful information for acute asthma exacerbations (AAE) in children. Previous antibiotic use within seven days is linked to pneumonia findings and antibiotic treatment in pediatric emergency departments.

Area of Science:

  • Pediatric Emergency Medicine
  • Pulmonology
  • Radiology

Background:

  • Acute asthma exacerbations (AAE) are a common reason for pediatric emergency department (PED) visits.
  • Chest radiography (CXR) is frequently used to detect pneumonia (PNA) in these children.
  • The clinical utility of CXR in AAE, balancing cost and radiation exposure, requires further investigation.

Purpose of the Study:

  • To identify patient characteristics associated with radiographic pneumonia (PNA) on CXR in children with AAE.
  • To determine patient characteristics linked to the initiation of antibiotic treatment in these cases.

Main Methods:

  • A retrospective chart review was conducted on 288 children with AAE who underwent CXR in a PED.
  • Univariate and multiple logistic regression analyses examined associations between patient characteristics and PNA or antibiotic administration.
  • Key factors analyzed included age, race, gender, fever, hypoxia, and prior antibiotic use.

Main Results:

  • Pneumonia (PNA) was identified on CXR in 15% of patients, and 17.8% received antibiotics.
  • No significant associations were found between PNA or antibiotic use and age, race, gender, insurance, arrival mode, fever, or hypoxia.
  • Previous antibiotic use within 7 days was significantly associated with both PNA on CXR (aOR 3.6) and antibiotic administration (aOR 3.3).

Conclusions:

  • Chest radiography (CXR) offers limited valuable information in pediatric acute asthma exacerbations (AAE).
  • Children with a history of antibiotic use within 7 days are more likely to be diagnosed with pneumonia (PNA) on CXR and receive antibiotics.
  • Further research is warranted to explore the roles of hypoxia and crackles in predicting outcomes.
Abstract

Keywords:
AsthmaChest radiographyEmergency departmentPediatricsPneumonia

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