Doubts over X-ray for pneumonia diagnosis in asthmatic children without fever or hypoxia
Among children with asthma exacerbations who underwent chest X-ray for suspected pneumonia, less than 6 percent of them actually had confirmed pneumonia after radiography, a recent study found.
These findings suggest that X-ray diagnosis might be unnecessary for some cases especially asthmatic children presenting without fever or hypoxia, according to the authors.
“Physicians often obtain chest radiographs to diagnose pneumonia in children with asthma, although less than 5 percent of children have pneumonia that can be radiographically confirmed,” said lead author Dr. Todd Florin of the Division of Emergency Medicine at Cincinnati Children’s Hospital Medical Center in Cincinnati, Ohio, US.
The high X-ray use in these children could be due to fear of missing pneumonia in these children, he said, as asthma and pneumonia have overlapping symptoms which can occur concomitantly.
Out of 14,007 emergency department (ED) visits for childhood asthma exacerbation, more than one third (4,708 cases; 33.6 percent) underwent chest X-ray, but only 280 out of those (5.9 percent) had confirmed pneumonia (radiographic pneumonia). [JAMA Pediatr 2016;doi:10.1001/jamapediatrics.2016.0310]
Children who presented with radiographic pneumonia at ED were more likely to be female (48.2 percent; odds ratio [OR], 1.29, 95 percent confidence interval [CI], 1.01-1.64; p=0.02), aged ≥5 years (67.1 percent; OR, 1.29, 95 percent CI, 1.47-2.48; p<0.001), have a fever of ≥38oC (36.1 percent; OR, 1.65, 95 percent CI, 1.27-2.15; p<0.001), or experience severe hypoxia (13.9 percent; OR, 1.88, 95 percent CI, 1.28-2.74; p<0.001).
Children with all the risk factors above had an OR of 7.59 (95 percent CI, 4.09-14.10) for having pneumonia compared with children without any of the risk factors.
“Our results suggest that routine use of radiography for younger children with asthma who are not febrile or hypoxic should be discouraged,” said Florin.
The retrospective cohort study analysed electronic health data of children aged between two to 18 years with asthma exacerbation who visited the ED during 2010-2013.
Overuse of X-rays could increase medical cost and expose children to unnecessary radiation and antibiotic use, the researchers said, noting that previous study has shown that bronchiolitic infants undergoing X-ray were more likely to receive antibiotics than those who did not undergo X-ray. [J Pediatr 2007;150:429-433]