The role of the chest radiograph in the management of childhood asthma.

Emergency Room records were analyzed retrospectively for 1548 asthma patient visits over a 24-month period. Chest x-rays were obtained during 391 visits. Five per cent had focal atelectasis, ten per cent had a pulmonary infiltrate. There was no difference between the x-ray results of those children successfully treated as outpatients and those requiring hospitalization. Physicians frequently ordered x-rays for asthmatic children under 5 years of age, for those with temperature greater than 38.3 C, symptoms longer than 2 days, respiratory rate greater than 40, a more severe attack with asthma score greater than 3, or pulmonary rales. Significantly abnormal chest radiographs (focal atelectasis or pulmonary infiltrate) were found only in patients under 5 years old or in older patients with pulmonary rales. The other patient characteristics which appeared to indicate a more severe asthma attack did not correlate with abnormal radiograph reports. The routine chest x-ray does not appear to provide useful information for the design of treatment plans for children with asthma.