Guidelines reduce X-ray and blood gas utilization in acute asthma

Gentile, Nina; Ufberg, Jacob W.; Barnum, Michael S; McHugh, Michelle K.; Karras, David J.

doi:10.1016/s0735-6757(03)00165-7

Cited by 37 publications

(32 citation statements)

References 19 publications

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“…Recommendations regarding the use of radiography in the National Heart, Lung, and Blood Institute guidelines [4][5][6] have been unchanged since 1991, and do not provide succinct recommendations to affect the discretionary use of radiographs; however, performance measures and benchmarks for the use of chest radiographs in ED care of asthma have been reported, [7][8][9] and studies have shown that many children presenting with respiratory illnesses can be managed safely and effectively in EDs without diagnostic imaging. 10,11 The average cost of a chest radiograph is $370. 12 The ED length of stay is increased by an average of 27 minutes when a radiograph is ordered.…”

Section: Discussionmentioning

confidence: 99%

“…Research has shown that using defined criteria can result in safe reductions in radiograph use in EDs. 10,11 A retrospective study from Australia of ED asthma care for children showed a significant reduction in unnecessary chest radiographs from 45.3% to 28.4% after the implementation of an education program with criteria that defined when a chest radiograph was unnecessary. 10 Similarly, another ED study outlined criteria for obtaining chest radiographs in asthma patients aged $19 years and decreased radiograph use by 55%.…”

Section: Figurementioning

confidence: 99%

“…There was no increase in ED return visits or the identification of pneumonia or other pathology on chest radiographs performed for hospitalized patients. 11 Although these studies outline local improvements, they provide evidence of successful behavior change in EDs. Replicating these results in US EDs will require the ability of ED providers and their organizations to adapt to the spread of new ideas as is described in the Institute for Health Care Improvement' s "A Framework for Spread: From Local Improvements to System-Wide Change."…”

Section: Figurementioning

confidence: 99%

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Variation and Trends in ED Use of Radiographs for Asthma, Bronchiolitis, and Croup in Children

2013

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WHAT'S KNOWN ON THIS SUBJECT: Variation in the emergency department (ED) use of radiographs for asthma, bronchiolitis, and croup exists. Unnecessary radiographs contribute to higher costs of care, decreased ED efficiency, and increased radiation in children.WHAT THIS STUDY ADDS: Despite no changes in guidelines to support routine use, there is a significant upward trend in the use of radiographs for children with emergency department visits for asthma. Pediatric-focused EDs use significantly fewer radiographs for asthma, bronchiolitis, and croup. abstract OBJECTIVES: The objectives were (1) to determine trends in radiograph use in emergency department (ED) care of children with asthma, bronchiolitis, and croup; and (2) to examine the association of patient and hospital factors with variation in radiograph use.METHODS: A retrospective, cross-sectional study of National Hospital Ambulatory Medical Care Survey data between 1995 and 2009 on radiograph use at ED visits in children aged 2 to 18 years with asthma, aged 3 months to 1 year with bronchiolitis, and aged 3 months to 6 years with croup. Odds ratios (ORs) were calculated and adjusted for all factors studied. RESULTS:The use of radiographs for asthma increased significantly over time (OR: 1.06; 95% confidence interval [CI]: 1.03-1.09; P , .001 for trend) but were unchanged for bronchiolitis and croup. Pediatric-focused EDs had lower use for asthma (OR: 0.44; 95% CI: 0.29-0.68), bronchiolitis (OR: 0.37; 95% CI: 0.23-0.59), and croup (OR: 0.34; 95% CI: 0.17-0.68). Compared with the Northeast region, the Midwest and South had statistically higher use of radiographs for all 3 conditions. The Western region had higher use only for asthma (OR: 1.67; 95% CI: 1.07-2.60), and bronchiolitis (OR: 2.94; 95% CI: 1. 48-5.87). No associations were seen for metropolitan statistical area or hospital ownership status. CONCLUSIONS:The ED use of radiographs for children with asthma increased significantly from 1995 to 2009. Reversing this trend could result in substantial cost savings and reduced radiation. Pediatricfocused EDs used significantly fewer radiographs for asthma, bronchiolitis, and croup. The translation of practices from pediatricfocused EDs to all EDs could improve performance. Pediatrics 2013;132:245-252 AUTHORS:

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Section: Discussionmentioning

confidence: 99%

Section: Figurementioning

confidence: 99%

Section: Figurementioning

confidence: 99%

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Variation and Trends in ED Use of Radiographs for Asthma, Bronchiolitis, and Croup in Children

2013

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“…These scores are used to facilitate communication between providers and to guide therapeutic interventions. Blood gas measurements are also frequently used to assess respiratory function in this population; however, blood gas analysis has been shown not to correlate with acute asthma severity or to predict respiratory failure (Gentile et al 2003 ). If the child is responding to therapy, hypercarbia alone is not an indication for intubation.…”

Section: Assessment Of Children With Acute Asthmamentioning

confidence: 99%

Pediatric Asthma

Carroll¹

2014

Pediatric and Neonatal Mechanical Ventilation

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“…3 That radiograph use was not decreased in centres with protocols may be due to the protocols being ignored or not adequately addressing best practice criteria for obtaining radiographs. Regardless of the reasons, the marked variation in opinions and practice patterns of clinicians seen in this and other reports is not acceptable yet is widely tolerated.…”

Section: Niranjan Kissoon MDmentioning

confidence: 99%

Unnecessary variation cloaked as discretion in medical decisions

Kissoon

2013

CJEM

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Guidelines reduce X-ray and blood gas utilization in acute asthma

Cited by 37 publications

References 19 publications

Variation and Trends in ED Use of Radiographs for Asthma, Bronchiolitis, and Croup in Children

Variation and Trends in ED Use of Radiographs for Asthma, Bronchiolitis, and Croup in Children

Pediatric Asthma

Unnecessary variation cloaked as discretion in medical decisions

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