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Chest radiography in the initial episode of bronchospasm in children: can clinical variables predict pathologic
C M Walsh-Kelly1, M K Kim, H M Hennes
1Department of Pediatrics, Medical College of Wisconsin, Milwaukee, USA.
Insights
Clinical variables cannot predict chest X-ray results in children with their first bronchospasm episode. Chest radiography remains recommended for diagnosing reactive airway disease (RAD) or other conditions.
Area of Science:
- Pediatric Emergency Medicine
- Pulmonology
- Radiology
Background:
- Bronchospasm is common in children, but differentiating causes via clinical signs alone is challenging.
- Chest radiography is often used, but its utility in guiding diagnosis for initial episodes needs evaluation.
Purpose of the Study:
- To assess if clinical or historical factors can accurately distinguish between normal, reactive airway disease (RAD), or pathologic chest radiography findings in children with a first-time bronchospasm episode.
Main Methods:
- A prospective case series of 633 children (newborn to 18 years) presenting with their first wheezing episode was conducted.
- Patients were seen in a tertiary academic pediatric emergency department.
Main Results:
- Only 6.2% of patients had pathologic chest radiography findings; 68% showed RAD, and 25.4% had normal findings.
- No single clinical variable accurately predicted pathologic findings.
- A discriminant function model using nine variables failed to reliably differentiate between the three radiographic groups.
Conclusions:
- Clinical variables, individually or in models, do not accurately identify children with pathologic chest radiography findings.
- Continued use of chest radiography is recommended for the initial evaluation of childhood bronchospasm.
Study Objective:
To determine whether historical or clinical variables can accurately discriminate among children, experiencing a first episode of bronchospasm, with chest radiography findings that are normal, consistent with reactive airway disease (RAD), or pathologic.
Methods:
We assembled a prospective case series of patients in our tertiary, academic, pediatric emergency department. All patients aged newborn to 18 years presenting to the ED with their initial episode of wheezing were enrolled.
Results:
Six hundred thirty-three patients presented to the ED during the study period. Pathologic radiographic findings were identified in 39 (6.2%). Radiographs revealing normal findings and evidence of RAD were noted in 25.4% and 68%, respectively. No single variable accurately predicted all pathologic radiographs. Discriminant function analysis identified nine variables, which we combined into a model. The model failed to accurately discriminate among patients with radiographs revealing evidence of a pathologic condition, normal chest findings, and RAD.
Conclusion:
No clinical variables, isolated or combined into a model, accurately identify patients with pathologic radiography findings. Continued use of chest radiography as a diagnostic intervention in the initial episode of childhood bronchospasm is recommended.
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