Evan H Allie1, Henry E Dingle2, William N Johnson3, Jeffrey R Birnbaum4, Melissa A Hilmes5, Sudha P Singh5, Donald H Arnold6. 1. Pediatric Emergency Medicine, Vanderbilt University Medical Center, Monroe Carell Jr. Childrens' Hospital, Nashville, TN, United States. Electronic address: Ehawkin86@gmail.com. 2. Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, United States. 3. Meharry Medical College, Nashville, TN, United States. 4. Pediatrics, Vanderbilt University Medical Center, Monroe Carell Jr. Childrens' Hospital, Nashville, TN, United States. 5. Pediatric Radiology, Vanderbilt University Medical Center, Monroe Carell Jr. Childrens' Hospital, Nashville, TN, United States. 6. Pediatric Emergency Medicine, Vanderbilt University Medical Center, Monroe Carell Jr. Childrens' Hospital, Nashville, TN, United States; Center for Asthma Research, Vanderbilt University School of Medicine, Nashville, TN, United States.
Abstract
BACKGROUND: Acute asthma exacerbations (AAE) account for many Pediatric Emergency Department (PED) visits. Chest radiography (CXR) is often performed in these patients to identify practice-changing findings such as pneumonia (PNA). Limited knowledge exists to balance the cost and radiation dose of CXR with expected yield of clinically meaningful information. OBJECTIVE: To determine in children with AAE with CXR, whether patient characteristics are associated with radiographic PNA; and significant practice change by initiation of antibiotic. DESIGN/ METHODS: Retrospective chart review of AAE patients with CXR performed in a PED in 2014. We examined univariate associations between patient characteristics and PNA on CXR and administration of antibiotic. Multiple logistic regression models then subsequently examined adjusted associations between patient characteristics and both outcomes. RESULTS: Of 288 patients, 43 (15%) had PNA on CXR and 51 (17.8%) received antibiotics. There were no statistically significant univariate associations between either outcome and age, race, gender, insurance status, mode of PED arrival, fever or hypoxia (all p>0.11). Crackles were associated with antibiotic administration (p=0.03), but not PNA on CXR (p=0.07). Only previous antibiotic use within 7days had both significant univariate associations (p=0.002) and adjusted associations with both PNA on CXR (aOR 3.6) and antibiotic administration (aOR 3.3). CONCLUSION: CXR infrequently adds valuable information in children with AAE. Patients treated with antibiotic within 7days are more likely to have PNA identified on CXR and receive antibiotics. A larger study is needed to examine potential significance of hypoxia and crackles.
BACKGROUND: Acute asthma exacerbations (AAE) account for many Pediatric Emergency Department (PED) visits. Chest radiography (CXR) is often performed in these patients to identify practice-changing findings such as pneumonia (PNA). Limited knowledge exists to balance the cost and radiation dose of CXR with expected yield of clinically meaningful information. OBJECTIVE: To determine in children with AAE with CXR, whether patient characteristics are associated with radiographic PNA; and significant practice change by initiation of antibiotic. DESIGN/ METHODS: Retrospective chart review of AAEpatients with CXR performed in a PED in 2014. We examined univariate associations between patient characteristics and PNA on CXR and administration of antibiotic. Multiple logistic regression models then subsequently examined adjusted associations between patient characteristics and both outcomes. RESULTS: Of 288 patients, 43 (15%) had PNA on CXR and 51 (17.8%) received antibiotics. There were no statistically significant univariate associations between either outcome and age, race, gender, insurance status, mode of PED arrival, fever or hypoxia (all p>0.11). Crackles were associated with antibiotic administration (p=0.03), but not PNA on CXR (p=0.07). Only previous antibiotic use within 7days had both significant univariate associations (p=0.002) and adjusted associations with both PNA on CXR (aOR 3.6) and antibiotic administration (aOR 3.3). CONCLUSION: CXR infrequently adds valuable information in children with AAE. Patients treated with antibiotic within 7days are more likely to have PNA identified on CXR and receive antibiotics. A larger study is needed to examine potential significance of hypoxia and crackles.
Authors: Eyal Cohen; Jonathan Rodean; Christina Diong; Matt Hall; Stephen B Freedman; Paul L Aronson; Harold K Simon; Jennifer R Marin; Margaret Samuels-Kalow; Elizabeth R Alpern; Rustin B Morse; Samir S Shah; Alon Peltz; Mark I Neuman Journal: JAMA Pediatr Date: 2019-08-05 Impact factor: 16.193
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