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Trends in Chest Radiographs for Pneumonia in Emergency Departments.
- Source :
-
Pediatrics [Pediatrics] 2020 Mar; Vol. 145 (3). Date of Electronic Publication: 2020 Feb 20. - Publication Year :
- 2020
-
Abstract
- Background and Objectives: National guidelines recommend against routine use of chest radiography (CXR) for community-acquired pneumonia (CAP) diagnosis in the pediatric emergency department (ED). Given that CXR is often used to exclude the diagnosis of CAP, a reduction in CXR use may result in overdiagnosis of CAP. We sought to evaluate trends in CXR use and assess the association between CXR performance and CAP diagnosis among children discharged from pediatric EDs.<br />Methods: Children 3 months to 18 years of age discharged from 30 US EDs with (1) CAP or (2) fever or respiratory illness between 2008 and 2018 were included. Temporal trends in CXR use and rates of CAP diagnoses among patients with fever or respiratory illness were assessed. Correlation between hospital-level CXR use and CAP diagnosis rates were evaluated by using Spearman's correlation weighted by hospital volume.<br />Results: CXR usage decreased from 86.6% to 80.4% ( P < .001) for patients with CAP and from 30.4% to 18.6% ( P < .001) for children with fever or respiratory illness over the 10-year study period. CAP diagnosis rates also declined from 7.8% to 5.9% ( P < .001). Hospital-level CXR use was correlated with pneumonia diagnosis rates (correlation coefficient 0.58; P < .001).<br />Conclusions: Over the past decade, there has been a decline in CXR use in the ED among children with pneumonia and respiratory illnesses, with a decrease in pneumonia diagnoses over the same time period. Future studies are needed to assess the role of CXR in the evaluation of children with possible pneumonia in the ED setting.<br />Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.<br /> (Copyright © 2020 by the American Academy of Pediatrics.)
- Subjects :
- Adolescent
Child
Child, Preschool
Cohort Studies
Cross-Sectional Studies
Female
Fever epidemiology
Humans
Infant
Interrupted Time Series Analysis
Male
Radiography, Thoracic statistics & numerical data
Retrospective Studies
United States epidemiology
Community-Acquired Infections diagnosis
Emergency Service, Hospital
Pneumonia diagnosis
Radiography, Thoracic trends
Subjects
Details
- Language :
- English
- ISSN :
- 1098-4275
- Volume :
- 145
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Pediatrics
- Publication Type :
- Academic Journal
- Accession number :
- 32079719
- Full Text :
- https://doi.org/10.1542/peds.2019-2816