Chest Radiographs Often Ordered in Children With Asthma and Chest Pain

By | November 4, 2018

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Compared with patients who did not report chest pain, physicians were more likely to obtain chest radiographs in patients who had reported chest pain at ED admission.
Compared with patients who did not report chest pain, physicians were more likely to obtain chest radiographs in patients who had reported chest pain at ED admission.

In children with acute asthma exacerbations who report chest pain, physicians frequently obtain chest radiographs (CXRs), according to a study published in Pediatric Emergency Care. Despite their common use, a substantial percentage of CXRs often report positive findings, which researchers suggest support the rationale of limiting their use in children.

Researchers from St. Louis, Missouri, retrospectively reviewed the charts of patients between ages of 2 and 18 years who presented with an acute asthma exacerbation to the emergency department (ED) at an urban tertiary care children’s hospital between August 1, 2014, and March 31, 2016 (n=793). Clinical data, as well as data regarding patient demographics, provider type, and CXR results were extracted, and pediatric radiologists interpreted the findings. A CXR was considered positive if evidence of pneumonia, pneumothorax, or pneumomediastinum was found.

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Of the 793 patients included in the study, 231 reported chest pain at their ED visit. A total of 184 patients underwent CXR; 74 (40.2%) had chest pain and 21 (11.4%) had a positive CXR. Compared with patients who did not report chest pain, physicians were more likely to obtain a CXR in patients who reported chest pain at ED admission (odds ratio [OR], 2.2; 95% CI, 1.5-3.2). Positive predictors for physicians obtaining CXR were white race (OR, 1.7; 95% CI, 1.1-2.8), history of temperature >101°F (OR, 2.4; 95% CI, 1.5-3.7), presence of crackles on physical assessment (OR, 5.0; 95% CI, 2.4-10.8), oxygen saturation of <93% (OR, 3.0; 95% CI, 2.0-4.7), and having an advanced practice nurse provider (OR, 1.7; 95% CI, 1.0-2.7).

A non-significant association between patients who reported chest pain and a higher likelihood of having a positive CXR (OR, 2.0; 95% CI, 0.7-5.6) was observed. Crackles on physical examination was the only statistically significant predictor of having a positive CXR (OR, 4.0; 95% CI, 1.2-13.0).

Study limitations included its retrospective design, the inclusion of patients from a single center, and the lack of blinding among the radiologists who interpreted the CXR results.

“The symptom of chest pain should be evaluated carefully but, as an isolated symptom, does not significantly increase the likelihood of a clinically important CXR finding,” the researchers concluded.

Reference

Majerus CR, Tredway TL, Yun NK, Gerard JM. Utility of chest radiographs in children presenting to a pediatric emergency department with acute asthma exacerbation and chest pain [published online September 25, 2018]. Pediatr Emerg Care. doi:10.1097/PEC.0000000000001615

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