Variation in Chest Radiograph Use for Children With Complicated Pneumonia Requiring Thoracostomy

Area of Science:

• Pediatric critical care
• Thoracic surgery
• Radiology

Background:

• Complicated pneumonia in children often requires chest tubes for management.
• Chest radiographs (CXRs) are frequently used to monitor these patients.
• Significant variation in CXR ordering practices among hospitals is suspected.

Purpose of the Study:

• To evaluate the variation in CXR ordering frequency for pediatric patients with complicated pneumonia requiring chest tubes.
• To assess the association between CXR ordering rates and patient outcomes, including complications, length of stay, costs, and readmissions.

Main Methods:

• Utilized the Pediatric Health Information System (PHIS) database for children aged 6 months to 18 years with complicated pneumonia undergoing thoracostomy (July 2019-June 2023).
• Calculated the proportion of daily CXRs ordered per encounter, adjusting for various factors.
• Hospitals were stratified into quartiles based on their median daily CXR ordering proportion to compare adjusted outcomes.

Main Results:

• A total of 1817 children were included; the median daily CXR proportion across all encounters was 0.68.
• Hospital-level median adjusted daily CXR proportions ranged from 0.30 to 0.91.
• No significant differences were found in pneumothorax, repeat thoracostomy, post-thoracostomy days, length of stay, or 30-day readmissions across CXR usage quartiles.
• Hospitals with higher CXR usage demonstrated significantly higher associated costs.

Conclusions:

• Substantial variation exists in the frequency of ordering chest radiographs for pediatric patients with complicated pneumonia requiring chest tubes.
• Higher rates of CXR ordering were associated with increased hospital costs without improving key patient outcomes.
• Further research is needed to identify clinical factors influencing chest tube complications and to guide optimal CXR ordering strategies.