Chest radiograph in the evaluation of first time wheezing episodes: Review of current clinical practice and efficacy

Mark G. Roback, David A. Dreitlein

Research output: Contribution to journalArticlepeer-review

38 Scopus citations

Abstract

Objective: To evaluate the current clinical use and utility of chest radiographs (CXR) in the workup of pediatric patients with first time wheezing (FTW) episodes. Setting: Urban children's hospital. Design: Retrospective review of medical records of patients seen in the emergency department in 1994 with disposition diagnoses of asthma or reactive airways disease, bronchiolitis, pneumonia, congenital heart disease, congestive heart failure, or foreign body aspiration to identify those patients presenting with FTW episodes. Methods: Clinical findings in FTW were compared in patients receiving a CXR (121, 41%) and those who did not (177, 59%). Comparisons were made between patients with a clinically significant CXR (CXR-pos) (29, 24%) and those without (92, 76%). CXR-pos was defined as a CXR result which would be expected to alter patient management. Comparisons between groups were analyzed using the two-tailed Student's t test for continuous variables and the X2 statistic for categorical data. The level of significance was determined at P < 0.05. Results: Two hundred ninety-eight episodes of FTW were identified of 1984 patient charts reviewed. Patients receiving CXR differed from those who did not by being of a greater age (39 vs 20 months, P < 0.01), having lower pulse oximetry (89.7 vs. 92.7%, P < 0.01), being less likely to have a family history of asthma (47.5 vs 63.2%, P < 0.01), or history of atopy (40.6 vs 59.4%, P < 0.01). Those with localized wheezes (59.4 vs 40.6% P < 0.01), localized rales (59.3 vs 40.7% P < 0.01), and localized decreased breath sounds (59.3 vs 40.7%, P = 0.01) were also more likely to receive a CXR. Among patients receiving CXR, clinical characteristics associated with CXR-pos were elevated temperature (37.9 vs 37.5°C, P = 0.04), absence of family history of asthma 72.6 vs 27.4%, P < 0.01), and the presence of localized wheezes (76.0 vs 24.0%, P = 0.02), or localized rales (76.0 vs 24.0%, P < 0.01). Conclusions: Clinicians in this setting do not routinely obtain a CXR in patients with FTW episodes. Retrospective examination of clinician practice revealed several clinical characteristics that were associated with increased use of CXR in FTW. Increased utility of the CXR was associated with patients having elevated temperature, an absence of a family history of asthma, and localized wheezes or rales by ausculatory examination.

Original languageEnglish (US)
Pages (from-to)181-184
Number of pages4
JournalPediatric Emergency Care
Volume14
Issue number3
DOIs
StatePublished - Jun 1998

Keywords

  • Asthma
  • Chest radiographs
  • First time wheezing

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