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Chest Radiography Use in Hospitalized Children with Acute Respiratory Tract Infections: A Baseline Analysis for
Roxana Axinte1,2, Sorin Axinte3,4, Elena Tătăranu2,3
1Doctoral School, George Emil Palade University of Medicine, Pharmacy, Science and Technology, 540142 Targu Mures, Romania.
Insights
Pediatric chest X-rays are overused in young children with respiratory infections, especially when guidelines suggest otherwise. This study highlights the need for targeted interventions to reduce unnecessary imaging and radiation exposure in this vulnerable population.
Area of Science:
- Pediatric radiology
- Respiratory medicine
- Healthcare quality improvement
Background:
- Pediatric respiratory infections are a major cause of emergency department visits and hospitalizations.
- Chest X-rays are frequently used despite guidelines recommending restrictive imaging, especially for uncomplicated cases in young children.
- Overutilization of imaging raises concerns about radiation exposure and resource allocation.
Purpose of the Study:
- Quantify potentially unnecessary chest radiography in hospitalized pediatric patients with respiratory infections.
- Identify age-related and diagnostic patterns for targeted imaging optimization.
- Provide data for quality improvement initiatives to reduce pediatric imaging.
Main Methods:
- Retrospective observational study of pediatric patients in a Romanian tertiary county hospital over 12 months.
- Analysis of electronic medical records for respiratory diagnoses, hospitalization, age, and chest radiography use.
- Statistical analysis to identify imaging patterns and correlations.
Main Results:
- Over 26,000 pediatric emergency presentations included; 1212 children hospitalized with respiratory infections.
- 3414 chest radiographs performed, with highest use in children aged 0-4 years.
- Negative correlation between patient age and imaging frequency (r = -0.70, p < 0.001); repeated imaging common in pneumonia, bronchiolitis.
Conclusions:
- Thoracic radiographs are disproportionately used in young children with respiratory infections.
- Imaging is often employed in conditions with limited indications, particularly in younger age groups.
- Findings establish a baseline for interventions to reduce unnecessary pediatric imaging and radiation exposure.
Abstract:
Background: Pediatric respiratory infections represent a leading cause of emergency department (ED) visits and hospitalizations. Chest X-rays are frequently used in their diagnostic evaluation, despite guideline recommendations advocating restrictive imaging strategies, particularly in young children with uncomplicated disease. Excessive imaging raises concerns regarding cumulative radiation exposure and inefficient resource utilization. Objectives: To quantify potentially unnecessary chest radiography use in hospitalized pediatric patients with respiratory infections and to identify age-related and diagnostic patterns suitable for targeted imaging optimization interventions. Methods: We conducted a retrospective observational study analyzing pediatric patients presented to the ED of a tertiary county hospital in Romania over a period of 12 months. Data regarding respiratory diagnoses, hospitalization status, patient age, and chest radiography utilization were extracted from electronic medical records. Results: Among more than 26,000 pediatric emergency presentations, 4139 children required hospitalization, of whom 1212 were diagnosed with respiratory infections. A total of 3414 chest radiographs were performed, with the highest imaging burden observed in children aged 0-4 years. Repeated imaging was common in interstitial pneumonia, bronchiolitis, and bronchial hyperreactivity. A strong negative correlation was identified between patient age and imaging frequency (r = -0.70, p < 0.001). Conclusions: Thoracic radiographs are disproportionately used in young children with respiratory infections, particularly in conditions with limited imaging indications. These findings provide an essential baseline for the development of targeted quality improvement interventions aimed at reducing unnecessary pediatric imaging.
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