A Single-Institution Experience in the Use of Chest Radiographs for Hospitalized Children Labelled as Asthma Exacerbation

Abstract

Background: Risks of cancer have become more notable lately, especially for young children with a chronic condition such as atopy. This study reports on cumulative radiation from chest radiographs in children with asthma. Its main aims were to consider our current practice, and suggest minimizing chest radiograph use in this vulnerable people. Methods: The study was retrospective and conducted at tertiary center. Eligibility criteria included children 2-15 y who were admitted between January-2017 and December-2018 for asthma management. Results: Of 643 children who were admitted as ‘asthma exacerbation’, 243 (40% females; age [mean±SD] 5.4±3.3 y) met the study criteria for inclusion. Ninety-two (38%) children had temperature 38.8±0.7oC on the day of admission. Antibiotics were prescribed for 148 (61%) children, mainly for presumed pneumonia. Chest radiographs were requested for 214 (88%) children, mainly on the day of admission. Only 38 (18%) chest radiographs showed focal/multifocal pneumonia justifying antibiotic use. Significant predictors for requesting chest radiographs were antibiotic use for presumed pneumonia, lower oxygen saturation at presentation, and requesting blood culture. Rate of chest radiographs per year was negatively related to child’s age; the younger the child the higher the rate (model coefficient -0.259, P<0.001). For children <5 y, rate of chest radiographs was 1.39±1.21/y and radiation dose 0.028±0.025 mSV/y. The corresponding rates for children ≥5 y were 0.78±0.72/y and 0.008±0.007 mSV/y, respectively (P<0.001). Conclusion: Chest radiographs were commonly requested for children with asthma, especially the young ones. Prospective studies are necessary to measure the impact of this practice on their health.