INTRODUCTION: The goals of this study are to identify factors associated with ordering of chest radiographs (CXR's) in children hospitalized with acute asthma exacerbations and determine the overall clinical impact of these CXR's. METHODS: A retrospective study was performed with children ≥ 2 years of age admitted from our emergency department (ED) between 6/1/2011 and 5/31/2012 with a primary diagnosis of acute asthma exacerbation or status asthmaticus. Patients were excluded if they had been on antibiotics prior to the emergency visit, received continuous albuterol or intravenous magnesium during the hospitalization, or had another chronic disease affecting lung function. RESULTS: 180 of the 405 children in the study (44%) had CXR's ordered, of which 18 (10%) had imaging that altered the patient's treatment plan. There were six cases of radiologist-diagnosed pneumonia, nine cases of atelectasis treated with antibiotics and three cases of pneumothorax. Factors associated with CXR ordering were: fever at home or in the ED (OR 4.5, 95% CI 2.8-7.4), triage oxygen saturation less than or equal to 92% (OR 1.8, 95% CI 1.2-2.7) and age 4 years or less (OR 2.3, 95% CI 1.4-3.7). Patients with treatment-altering CXR's were more likely to have oxygen saturations less than or equal to 92% (OR 4.2, 95% CI 1.4-13.0; p = 0.006) or fever in the ED (OR 3.8, 95% CI 1.0-13.6; p < 0.05). No patients with triage oxygen saturation above 96% had a treatment-altering CXR. CONCLUSIONS: The majority of CXR's ordered in pediatric inpatients with asthma exacerbation do not provide clinically relevant information.
INTRODUCTION: The goals of this study are to identify factors associated with ordering of chest radiographs (CXR's) in children hospitalized with acute asthma exacerbations and determine the overall clinical impact of these CXR's. METHODS: A retrospective study was performed with children ≥ 2 years of age admitted from our emergency department (ED) between 6/1/2011 and 5/31/2012 with a primary diagnosis of acute asthma exacerbation or status asthmaticus. Patients were excluded if they had been on antibiotics prior to the emergency visit, received continuous albuterol or intravenous magnesium during the hospitalization, or had another chronic disease affecting lung function. RESULTS: 180 of the 405 children in the study (44%) had CXR's ordered, of which 18 (10%) had imaging that altered the patient's treatment plan. There were six cases of radiologist-diagnosed pneumonia, nine cases of atelectasis treated with antibiotics and three cases of pneumothorax. Factors associated with CXR ordering were: fever at home or in the ED (OR 4.5, 95% CI 2.8-7.4), triage oxygen saturation less than or equal to 92% (OR 1.8, 95% CI 1.2-2.7) and age 4 years or less (OR 2.3, 95% CI 1.4-3.7). Patients with treatment-altering CXR's were more likely to have oxygen saturations less than or equal to 92% (OR 4.2, 95% CI 1.4-13.0; p = 0.006) or fever in the ED (OR 3.8, 95% CI 1.0-13.6; p < 0.05). No patients with triage oxygen saturation above 96% had a treatment-altering CXR. CONCLUSIONS: The majority of CXR's ordered in pediatric inpatients with asthma exacerbation do not provide clinically relevant information.
Authors: Amanda F Messer; Esther M Sampayo; Brent Mothner; Elizabeth A Camp; Jennifer Jones; Terri Brown; Joyee Vachani Journal: Pediatr Qual Saf Date: 2019-12-05
Authors: Valentina Fainardi; Carlo Caffarelli; Barbara Maria Bergamini; Loretta Biserna; Paolo Bottau; Elena Corinaldesi; Arianna Dondi; Martina Fornaro; Battista Guidi; Francesca Lombardi; Maria Sole Magistrali; Elisabetta Marastoni; Alessandra Piccorossi; Maurizio Poloni; Sylvie Tagliati; Francesca Vaienti; Cristina Venturelli; Giampaolo Ricci; Susanna Esposito Journal: Int J Environ Res Public Health Date: 2021-12-03 Impact factor: 3.390
Authors: Ayman A Al-Eyadhy; Mohamad-Hani Temsah; Ali A N Alhaboob; Abdulmalik K Aldubayan; Nasser A Almousa; Abdulrahman M Alsharidah; Mohammed I Alangari; Abdulrahman M Alshaya Journal: Ann Thorac Med Date: 2015 Oct-Dec Impact factor: 2.219