X-rays Questioned for Asthma Exacerbation Without Fever, Hypoxia

By Anne Harding

June 08, 2016

NEW YORK (Reuters Health) - Radiography should not be used routinely to detect pneumonia in young children with asthma who do not have fever or hypoxia, according to new research.

Based on the findings, clinicians should "limit the use of chest radiography to those children who really are at higher risk for pneumonia, which in our study were children 5 years and older, children with a fever, and children who were hypoxic," Dr. Todd Florin of Cincinnati Children's Hospital Medical Center, told Reuters Health by phone.

Fewer than 5% of children with asthma exacerbations who present to the emergency department will have pneumonia that can be radiologically confirmed, Dr. Florin and his colleagues note in their report, online June 6 in JAMA Pediatrics. Nevertheless, they add, physicians "often" perform chest radiographs in children with asthma to diagnose pneumonia, given the overlap in symptoms between the two conditions.

To identify risk factors for pneumonia, the researchers looked retrospectively at a cohort of 14,007 children who presented to their ED with asthma exacerbation between 2010 and 2013. One-third of the children received chest radiographs, 5.9% of whom had radiographically confirmed pneumonia.

Factors independently associated with pneumonia included age 5 years or older, female sex, fever, and oxygen saturation below 90%. For example, a child with all of these risk factors had an odds ratio of 7.59 for having pneumonia compared to a child with none of these.

"Trying to hone in on the diagnosis clinically can be challenging, and that's why I think X-ray use is so high in these children with asthma exacerbations, because there's a fear of missing pneumonia," Dr. Florin said.

While unnecessary X-rays increase cost and expose children to radiation, a bigger concern may be that they could increase antibiotic overuse, according to the researcher. A study in infants with bronchiolitis found that just receiving an X-ray made a child more likely to be prescribed antibiotics, he noted, so it's possible that unnecessary X-rays could lead to antibiotic overuse in this population as well.

The National Institutes of Health supported this research. The authors made no disclosures.

SOURCE: http://bit.ly/1PfRBA2

JAMA Pediatr 2016.