Pediatric Emergency Medicine Fellow Physician University of Michigan Ann Arbor, Michigan, United States
Background: Chest radiography (CXR) rarely benefits children who present to the emergency department (ED) with mild asthma exacerbations. Multiple clinical practice guidelines recommend avoidance of routine CXR for asthma unless an alternative diagnosis is suspected. Objective: To analyze factors and outcomes associated with CXR in children with mild asthma exacerbations at an academic pediatric ED. Design/Methods: We retrospectively collected data for patients between 2 to 21 years old who were evaluated at our ED during 2021 and 2022 for wheezing and discharged after receiving bronchodilators and/or corticosteroids. Patients with foreign body ingestion, cardiac disease, immunosuppression, tracheostomy, cystic fibrosis, severe neurologic disorders, and sickle cell disease were excluded. Descriptive statistics and a multivariable regression model were used to determine associations between factors and CXR. Results: Of 848 patients, 488 (58%) were male. The mean age was 8.6 years. 238 (28%) patients received CXR. Demographic factors (shown as adjusted odds ratio with 95% confidence interval [CI]) associated with CXR included White/Caucasian race (1.52 [1.05-2.19]), lack of primary care access (3.53 [1.46-8.53]), and private insurance (1.73 [1.12-2.68]). Clinical factors associated with CXR included respiratory symptoms over 2 days (2.41, [1.68-3.44]), fever (3.24 [2.06-5.11]), and tachypnea (1.67 [1.19-2.35]). Care by attending physicians without resident or fellow trainees was associated with CXR (1.72 [1.22-2.43]). CXR was not significantly associated with patient age or attending physician specialty. Antibiotics were prescribed to 14 (6%) patients who received CXR. There was no difference in the rate of ED return visits within three days between the two groups.
Conclusion(s): We found an increased association of CXR in mild pediatric asthma exacerbations with multiple factors. Quality initiatives should be aimed towards demographic, clinical, and provider factors to reduce unnecessary CXR for pediatric asthma in the ED.
