Use of Chest X-rays Doubled in 15 Years for Kids With Asthma

The use of chest radiographs on millions of children who visited emergency departments (EDs) with moderate to severe asthma increased 2.4-fold during a 15-year period, according to a retrospective cross-sectional study. However, the study showed that EDs that predominately served pediatric patients bucked the worrisome trend.

Jane F. Knapp, MD, from the Department of Pediatrics at Children's Mercy Hospitals and Clinics in Kansas City, Missouri, and colleagues report their findings in an article published online July 22 in Pediatrics.

Asthma, bronchiolitis, and croup accounted for 13.3 million ED visits by children from 1995 to 2009. Indeed, respiratory ailments rank among the top 10 reasons children younger than 17 years visit the ED.

In a previous study, Dr. Knapp and colleagues found a high rate of use of diagnostic imaging in EDs in 2005 for children with respiratory illness, although many of these cases can be managed without such testing. Moreover, the authors note that national treatment guidelines have not budged since 1991, nor has there been a spike in severity of respiratory symptoms.

To understand nationwide trends in discretionary ED use of radiographs for asthma, bronchiolitis, and croup, the researchers turned to National Hospital Ambulatory Medical Care Survey data, a probability sample used to collect information on visits to nonfederal, general, and short-stay hospitals.

"There was a statistically significant upward trend over time in ED use of radiographs at visits for moderate to severe asthma (odds ratio [OR]: 1.06; 95% confidence interval [CI]: 1.03–1.09: P < .001 for trend)," Dr. Knapp and colleagues write. "Over the entire 15-year span, this trend represents a 2.4-fold increase in the odds of use."

"Regional increases in use were noted for all conditions in the Midwest (OR: 1.57 [95% CI: 1.12–2.22] for asthma; OR: 2.15 [95% CI: 1.17–3.95] for bronchiolitis; and OR: 1.80 [95% CI, 1.01–3.24] for croup) and in the South (OR: 2.27 [95% CI: 1.52–3.38] for asthma; OR: 1.92 [95% CI: 1.06–3.47] for bronchiolitis; and OR: 3.14 [95% CI: 1.81–5.46] for croup)," the authors continue.

EDs that overwhelmingly see pediatric patients (80% or more of visits are made by children younger than 18 years) were a bright spot. There, the use of radiographs for asthma, bronchiolitis, and croup decreased. With chest radiographs averaging $370 and lengthening ED stays by an average of 27 minutes, the authors note a substantial opportunity to improve care and reduce costs if more EDs followed the example of pediatric-focused facilities.

"We studied trends and patterns in performance in the ED use of radiographs for asthma, bronchiolitis, and croup and found that radiograph use in moderate-to-severe asthma has increased," the researchers conclude. "Reversing this trend could improve ED efficiency, decrease costs, and decrease radiation exposure."

The authors have disclosed no relevant financial relationships.

Pediatrics. Published online July 22, 2013. Abstract

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