A chest radiograph (CXR) is not routinely indicated in children presenting with their first episode of wheezing; however, it continues to be overused. A survey was distributed electronically to determine what trainees are taught and their current practice of obtaining a CXR in children presenting with their first episode of wheezing and the factors that influence this practice. Of the 1513 trainees who completed surveys, 35.3% (535/1513) reported that they were taught that pediatric patients presenting with their first episode of wheezing should be evaluated with a CXR. In all, 22.01% (333/1513) indicated that they would always obtain a CXR in these patients, and 13.75% (208/1513) would always obtain a CXR under a certain age (4 weeks to 12 years, median of 2 years). Our study identifies a target audience that would benefit from education to decrease the overuse of CXRs in children.
FreyUvon MutesE. The challenge of managing wheezing in infants. N Engl J Med. 2009;360:2130-2133.
2.
AlpernERClarkAEAlessandriniEA, et al. Recurrent and high-frequency use of the emergency department by pediatric patients. Acad Emerg Med. 2014;21:365-373.
3.
BisgaardHSzeflerS. Prevalence of asthma-like symptoms in young children. Pediatr Pulmonol. 2007;42:723-728.
SlyRM. Asthma. In: BehrmanREKliegmanRMArvinAM, eds. Nelson Textbook of Pediatrics. 15th ed.WB Saunders; 1996:63.
6.
Walsh-KellyCMKimMKHennesHM. Chest radiography in the initial episode of bronchospasm in children: can clinical variables predict pathologic findings?Ann Emerg Med. 1996;28:391-395.
7.
RushtonAR. The role of the chest radiograph in the management of childhood asthma. Clin Pediatr (Phila). 1982;21:325-328.
8.
BrooksLFCloutierMMAfshaniC. Significance of roentgenographic abnormalities in children hospitalized for asthma. Chest. 1982;82:315-318.
9.
KingBRKharaschSJBaskinMN. New onset wheezing. Pediatr Emerg Care. 1994;10:178-180.
10.
BadaCCarreazoNYChalcoJPHuichoL. Inter-observer agreement in interpreting chest X-rays on children with acute lower respiratory tract infections and concurrent wheezing. Sao Paulo Med J. 2007;125:150-154.
11.
RalstonSLLieberthalASMeissnerHC, et al. Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis. Pediatrics. 2014;134:e1474-e1502.
12.
National Asthma Education and Prevention Program. Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma. National Heart, Lung, and Blood Institute; 2007.
13.
Mahabee-GittensEMBachmanDTShapiroEDDowdMD. Chest radiographs in the pediatric emergency department for children < or = 18 months of age with wheezing. Clin Pediatr (Phila). 1999;38:395-399.
14.
RobackMGDreitleinDA. Chest radiograph in the evaluation of first time wheezing episodes: review of current clinical practice and efficacy. Pediatr Emerg Care. 1998;14:181-184.
15.
SchuhSLalaniAAllenU, et al. Evaluation of the utility of radiography in acute bronchiolitis. J Pediatr. 2007;150:429-433.
16.
BuckmasterABoonR. Reduce the rads: a quality assurance project on reducing unnecessary chest X-rays in children with asthma. J Paediatr Child Health. 2005;41:107-111.
17.
ZorcJJHallCB. Bronchiolitis: recent evidence on diagnosis and management. Pediatrics. 2010;125:342-349.
18.
KnappJFHallMSharmaV. Benchmarks for the emergency department care of children with asthma, bronchiolitis, and croup. Pediatr Emerg Care. 2010;26:364-369.
19.
KnappJFSimonSDSharmaV. Quality of care for common pediatric respiratory illnesses in United States emergency departments: analysis of 2005 National Hospital Ambulatory Medical Care Survey Data. Pediatrics. 2008;122:1165-1170.
20.
JohnsonLWRoblesJHudginsAOsburnSMartinDThompsonA. Management of bronchiolitis in the emergency department: impact of evidence-based guidelines?Pediatrics. 2013;131(suppl 1):S103-S109.
21.
HoSWHuangKYTengYHKuMSChiouJY. Practice variations between emergency physicians and pediatricians in treating acute bronchiolitis in the emergency department. J Emerg Med. 2015;48:536-541.
22.
KnappJFSimonSDSharmaV. Variation and trends in ED use of radiographs for asthma, bronchiolitis, and croup in children. Pediatrics. 2013;132:245-252.
KocherKEMeurerWJDesmondJS, et al. Effect of testing and treatment on emergency department length of stay using a national database. Acad Emerg Med. 2012;19:525-534.
25.
PatelNHHassounAChaoJH. The practice of obtaining a chest X-ray in pediatric patients presenting with their first episode of wheezing in the emergency department: a survey of attending physicians. Pediatr Emerg Care. 2020;36:16-20.
26.
StarlingSPHeislerKWPaulsonJFYoumansE. Child abuse training and knowledge: a national survey of emergency medicine, family medicine, and pediatric residents and program directors. Pediatrics. 2009;123:e595-e602.
27.
BreakeyVRPirieJGoldmanRD. Pediatric and emergency medicine residents’ attitudes and practices for analgesia and sedation during lumbar puncture in pediatric patients. Pediatrics. 2007;119:e631-e636.
28.
MunizAE. Emergency medicine versus pediatric emergency medicine physicians in the management of febrile infants <1 month of age. Ann Emerg Med. 2013;54(3, suppl):S106.
29.
BelferRAGittelmanMAMuñizAE. Management of febrile infants and children by pediatric emergency medicine and emergency medicine: comparison with practice guidelines. Pediatr Emerg Care. 2001;17:83-87.
30.
HampersLCFariesSG. Practice variation in the emergency management of croup. Pediatrics. 2002;109:505-508.
31.
CrainEFWeissKBFaganMJ. Pediatric asthma care in US emergency departments: current practice in the context of the National Institutes of Health guidelines. Arch Pediatr Adolesc Med. 1995;149:893-901.
32.
LiPToTParkinPCAndersonGMGuttmannA. Association between evidence-based standardized protocols in emergency departments with childhood asthma outcomes. Arch Pediatr Adolesc Med. 2012;166:834-840.
33.
BhargavanMSunshineJH. Utilization of radiology services in the United States: levels and trends in modalities, regions, and populations. Radiology. 2005;234:824-832.
34.
ParkerLLevinDCFrangosARaoVM. Geographic variation in the utilization of noninvasive diagnostic imaging: national Medicare data, 1998-2007. AJR Am J Roentgenol. 2010;194:1034-1039.
35.
RalstonSGarberMNarangS, et al. Decreasing unnecessary utilization in acute bronchiolitis care: results from the value in inpatient pediatrics network. J Hosp Med. 2013;8:25-30.
BrinkJAAmisESJr. Image Wisely: a campaign to increase awareness about adult radiation protection. Radiology. 2010;257:601-602.
38.
GentileNTUfbergJBarnumMMcHughMKarrasD. Guidelines reduce X-ray and blood gas utilization in acute asthma. Am J Emerg Med. 2003;21:451-453.
39.
AkenroyeATBaskinMNSamnalievMStackAM. Impact of a bronchiolitis guideline on ED resource use and cost: a segmented time-series analysis. Pediatrics. 2014;133:e227-e234.
40.
MittalVDarnellCWalshB, et al. Inpatient bronchiolitis guideline implementation and resource utilization. Pediatrics. 2014;133:e730-e737.
41.
BekmezianAFeeCWeberE. Clinical pathway improves pediatrics asthma management in the emergency department and reduces admissions. J Asthma. 2015;52:806-814.
42.
StuddertDMMelloMMSageWM, et al. Defensive medicine among high-risk specialist physicians in a volatile malpractice environment. JAMA. 2005;293:2609-2617.
43.
WaxmanDAGreenbergMDRidgelyMSKellermannALHeatonP. The effect of malpractice reform on emergency department care. N Engl J Med. 2014;371:1518-1525.
44.
Smith-BindmanRMcCullochCEDingAQualeCChuPW. Diagnostic imaging rates for head injury in the ED and states’ medical malpractice tort reforms. Am J Emerg Med. 2011;29:656-664.
45.
Woods-HillCZKoontzDWKingAF, et al; Bright Star Authorship Group. Practices, perceptions, and attitudes in the evaluation of critically ill children for bacteremia: a national survey. Pediatr Crit Care Med. 2020;21:e23-e29.
