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The usefulness of chest radiographs in first asthma attacks
Insights
Routine chest X-rays are often unnecessary for children experiencing their first asthma attack. Most cases show uncomplicated asthma, but clinical evaluation can identify those who may benefit from imaging due to specific symptoms.
Area of Science:
- Pediatric Pulmonology
- Diagnostic Imaging
- Emergency Medicine
Background:
- Acute asthma attacks in children are common presentations in emergency settings.
- The utility of routine chest radiography in first-time asthma exacerbations remains a subject of clinical debate.
- Identifying children who might benefit from imaging is crucial for resource allocation and appropriate care.
Purpose of the Study:
- To evaluate the diagnostic yield of routine chest radiography in children presenting with their first episode of wheezing.
- To determine the incidence of abnormal radiographic findings in this pediatric population.
- To identify clinical predictors that may indicate the need for chest X-rays in acute asthma.
Main Methods:
- A prospective study of 371 children over one year of age presenting with their initial asthma exacerbation.
- Analysis of chest radiography findings, categorizing them as uncomplicated asthma or positive for specific abnormalities.
- Correlation of radiographic results with pre- and post-treatment clinical signs and symptoms, including respiratory rate, heart rate, and auscultation findings.
Main Results:
- Over 94% of children (350/371) had normal chest X-rays, consistent with uncomplicated asthma.
- Abnormal findings (atelectasis, pneumonia, pneumomediastinum) were present in 5.7% (21/371) of patients.
- Children with positive radiographs were significantly more likely to exhibit tachypnea, tachycardia, and localized auscultatory findings, and required hospitalization more often.
Conclusions:
- Routine chest radiography is not indicated for most children experiencing their first acute asthma attack.
- Clinical assessment, including tachypnea, tachycardia, fever, and localized chest signs, can effectively identify a subset of patients likely to have abnormal radiographs.
- Selective use of chest X-rays based on clinical suspicion can optimize diagnostic utility and avoid unnecessary procedures.
Abstract:
To assess the value of routine chest radiography during acute first attacks of asthma, we studied 371 consecutive children over one year of age who presented with an initial episode of wheezing. Three hundred fifty children (94.3 per cent) had radiographic findings that were compatible with uncomplicated asthma and were considered negative. Twenty-one (5.7 per cent) had positive findings: atelectasis and pneumonia were noted in seven, segmental atelectasis in six, pneumonia in five, multiple areas of subsegmental atelectasis in two, and pneumomediastinum in one. The patients with positive films were more likely to have a respiratory rate above 60 or a pulse rate above 160 (P less than 0.001), localized rales or localized decreased breath sounds before treatment (P less than 0.01), and localized rales (P less than 0.005) and localized wheezing (P less than 0.02) after treatment; also, these patients were admitted to the hospital more often (P less than 0.001). Ninety-five per cent (20 of 21) of the children with positive films could be identified before treatment on the basis of a combination of tachypnea, tachycardia, fever, and localized rales or localized decreased breath sounds. Most first-time wheezers will not have positive radiographs; careful clinical evaluation should reveal which patients will have abnormal radiographs and will therefore benefit from the procedure.