Pneumonia Found Infrequently on Chest X-Ray in Children With Acute Asthma Exacerbations

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Chest radiography may likely be deferred for a period of time in certain children presenting to the pediatric emergency department with acute asthma exacerbations.
Chest radiography may likely be deferred for a period of time in certain children presenting to the pediatric emergency department with acute asthma exacerbations.

Chest radiography infrequently identifies pneumonia or results in a change in standard management of children who go to the pediatric emergency department (PED) for acute asthma exacerbations. In a study published in the American Journal of Emergency Medicine, Evan H. Allie, MD, of the Pediatric Emergency Medicine Department, Vanderbilt University Medical Center, Nashville, Tennessee, and colleagues found that although chest radiography rarely adds valuable information in these cases, it is often performed.

In this retrospective chart review of 288 pediatric patients being evaluated in the PED with acute asthma exacerbations, chest radiograph identified pneumonia in only 43 children (15%), and 51 children (17.8%) received antibiotics.

There were no statistically significant associations between performing chest radiograph or receiving antibiotics and age, race, gender, insurance status, mode of PED arrival, fever, or hypoxia. The finding of crackles was associated with antibiotic administration (P =0.03), but not with pneumonia (P=0.07) on radiograph. 

Previous antibiotic use within 7 days, however, showed both significant univariate associations (P =0.002) and adjusted associations with both pneumonia on chest radiograph (adjusted odds ratio [aOR], 3.6) and antibiotic administration (aOR, 3.3).

Study limitations include a number inherent to a retrospective chart review, such as the potential for missing or incorrect data and the potential for selection bias. Additionally, the International Classification of Diseases-9 codes used for screening charts for study inclusion have not been validated for study purposes and may have resulted in the exclusion of appropriate patients. In addition, the interpretation of chest radiographs for pneumonia is subjective.

The authors concluded that chest radiography may be deferred for a period of time in children presenting to the PED with acute asthma exacerbations. However, antibiotic treatment several days prior to the PED visit may be predictive of positive chest radiograph findings and treatment for pneumonia. They call for a larger study to determine the value of chest radiography when a child presents to the PED with hypoxia and crackles.

Reference

Allie EH, Dingle HE, Johnson WN, et al. Emergency department chest radiography for children with asthma exacerbation is infrequently associated with change of management [Published online October 6, 2017] Am J Emerg Med. doi: 10.1016/j.ajem.2017.10.009

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