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 7 days 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 7 days 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.
Abbreviations:
AAE (Acute Asthma Exacerbation), PED (Pediatric Emergency Department), CXR (Chest Radiograph), PNA (Pneumonia)Keywords
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Article Info
Publication History
Published online: October 06, 2017
Accepted:
October 5,
2017
Received in revised form:
October 4,
2017
Received:
July 12,
2017
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
