Utility of Chest Radiographs in Children Presenting to a Pediatric Emergency Department With Acute Asthma Exacerbation and Chest Pain

Abstract

Objectives: Previous studies have not evaluated the utility of obtaining chest radiographs (CXR) in patients with acute asthma exacerbation reporting chest pain. The aims of this study were to evaluate the symptom of chest pain as a predictor for clinicians obtaining a CXR in these patients and to evaluate chest pain as a predictor of a positive CXR finding.Methods: This was a retrospective chart review of patients, ages 2 to 18 years, presenting for acute asthma exacerbation to the emergency department from August 1, 2014, to March 31, 2016. Data collected included demographics, clinical data, provider type, and CXR results. Chest radiographs were classified as positive if they showed evidence of pneumonia, pneumothorax, or pneumomediastinum. Multivariate logistic regression models were developed with dependent variables of "obtaining a CXR" and "a positive CXR finding."Results: Seven hundred ninety-three subjects were included in the study.Two hundred thirty-one (29.1%) reported chest pain. Chest radiographs were obtained in 184 patients (23.2%). Of those, 74 patients (40.2%) had chest pain and 21 (11.4%) had a positive CXR. Providers were more likely to obtain CXRs in patients who reported chest pain (odds ratio = 2.2 [95% confidence interval = 1.5-3.2]). Patients reporting chest pain were more likely to have a positive CXR although this difference was not statistically significant (odds ratio = 2.0 [95% confidence interval = 0.7-5.6]).Conclusions: Providers are more likely to obtain CXRs in asthmatic patients complaining of chest pain; however, these CXRs infrequently yield positive findings. This further supports limiting the use of chest radiography in patients with acute asthma exacerbation.

The Buddhasothorn Asthma Severity Score (BASS): A practical screening tool for predicting severe asthma exacerbations for pediatric patients

“…29 Moreover, chest radiography was performed for patients with acute asthma exacerbations having fever, oxygen saturation of ≤92% in room air, younger age group (≤4 years of age), and for those who complain chest pain. 30,31 Certainly, physicians must confirm the diagnosis of pneumonia, pneumothorax, or pneumomediastinum to assist decision-making for treating acute asthmatic patients presented with such positive findings.…”

Lung Ultrasound to Detect Pneumothorax in Children Evaluated for Acute Chest Pain in the Emergency Department: An Observational Pilot Study

“…The high accuracy of LUS for PNX in our study can have practical implications. Pediatric studies have shown the high rate of CXRs performed by emergency pediatricians evaluating children with acute chest pain ( 30 , 31 ). Considering the ability of LUS in detecting PNX, the high negative predictive value for PNX, and the available data on the accuracy of LUS in detecting PNX, the routine application of LUS can allow a high reduction of CXR-related costs and radiation exposure for the evaluation of acute chest pain in the pED.…”

Pediatric Chest Pain: A Review of Diagnostic Tools in the Pediatric Emergency Department

“…Pulmonary system-related chest pain is also not highly prevalent, accounting for 1.82–12.78% [ 1 , 9 , 12 , 14 , 15 , 16 , 17 , 31 ], with common causes including pneumothorax, asthma, pneumonia, and the less common pneumomediastinum [ 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 ]. Some of these diseases can be potentially life-threatening, such as tension pneumothorax.…”

“…Chest radiography is also a common examination for children and adolescents with acute chest pain. In previous studies, 35.6–72.0% of pediatric patients with chest pain underwent chest radiography [ 1 , 9 , 12 , 13 , 33 ]. Common positive findings on chest radiography included pneumonia/bronchitis, pneumomediastinum, pneumothorax, pneumopericardium, and cardiomegaly.…”