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Association of Chest Radiography With Outcomes in Pediatric Pneumonia: A Population-Based Study
Alexandra T Geanacopoulos1,2, Mark I Neuman1,2, Susan C Lipsett1,2
1Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
Insights
Chest X-rays (CXRs) in children with community-acquired pneumonia (CAP) discharged from the emergency department (ED) were linked to a slight decrease in 7-day hospitalizations. This suggests CXRs aid in prognostic evaluation for pediatric CAP patients.
Area of Science:
- Pediatric Emergency Medicine
- Radiology
- Infectious Diseases
Background:
- Community-acquired pneumonia (CAP) is a common diagnosis in children presenting to emergency departments (EDs).
- Chest radiography (CXR) is frequently utilized for CAP evaluation in the ED setting.
- The impact of CXR on clinical outcomes for pediatric CAP patients discharged from the ED requires further investigation.
Purpose of the Study:
- To assess the association between undergoing CXR and 7-day hospitalization after ED discharge in children diagnosed with CAP.
- To evaluate the relationship between CXR performance at the patient and ED levels with subsequent hospitalizations.
Main Methods:
- Retrospective cohort study of children aged 3 months to 17 years discharged from EDs across 8 states (2014-2019).
- Mixed-effects logistic regression models were used to analyze the association of CXR with 7-day hospitalization, adjusting for illness severity.
- Secondary outcomes included 7-day ED revisits and hospitalizations for severe CAP.
Main Results:
- Among 206,694 children with CAP, 7-day hospitalization rates were 1.6%.
- Adjusted analysis revealed CXR was associated with a reduction in 7-day hospitalizations (aOR: 0.82, 95% CI: 0.73-0.92).
- EDs with higher CXR utilization showed significantly lower rates of 7-day hospitalizations, ED revisits, and severe CAP hospitalizations.
Conclusions:
- In children with CAP discharged from the ED, CXR performance was associated with a statistically significant, albeit small, reduction in 7-day hospitalizations.
- CXR may serve as a valuable tool for prognostic assessment in pediatric CAP patients managed in the emergency department.
Objective:
Chest radiograph (CXR) is often performed for the evaluation of community-acquired pneumonia (CAP) in the ED setting. We sought to evaluate the association of undergoing CXR with 7-day hospitalization after emergency department (ED) discharge among patients with CAP.
Methods:
This was a retrospective cohort study including children 3 months to 17 years discharged from any ED within 8 states from 2014 to 2019. We evaluated the association of CXR performance with 7-day hospitalization at both the patient and ED levels using mixed-effects logistic regression models accounting for markers of illness severity. Secondary outcomes included 7-day ED revisits and 7-day hospitalization with severe CAP.
Results:
Among 206 694 children with CAP, rates of 7-day ED revisit, hospitalization, and severe CAP were 8.9%, 1.6%, and 0.4%, respectively. After adjusting for illness severity, CXR was associated with fewer 7-day hospitalizations (1.6% vs. 1.7%, adjusted odds ratio: [aOR] 0.82, 95% confidence interval [CI]: 0.73-0.92). CXR performance varied somewhat between EDs (median 91.5%, IQR: 85.3%-95.0%). EDs in the highest quartile had fewer 7-day hospitalizations (1.4% vs 1.9%, aOR: 0.78, 95% CI: 0.65-0.94), ED revisits (8.5% vs 9.4%, aOR: 0.88, 95% CI: 0.80-0.96) and hospitalizations for severe CAP (0.3% vs. 0.5%, aOR: 0.70, 95% CI: 0.51-0.97) as compared to EDs with the lowest quartile of CXR utilization.
Conclusions:
Among children discharged from the ED with CAP, performance of CXR was associated with a small but significant reduction in hospitalization within 7 days. CXR may be helpful in the prognostic evaluation of children with CAP discharged from the ED.
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