ED x-rays for kids with asthma spike

Emergency department (ED) use of chest x-rays for children presenting with moderate to severe asthma increased significantly from 1995 to 2009. Pediatric EDs bucked the trend, indicating a need to transfer best practices to standard EDs, which could improve efficiency, cut costs and decrease radiation exposure, according to a study published in the August issue of Pediatrics.

Research has indicated that many children presenting to the ED with respiratory illnesses can be managed safely and effectively without imaging. The average chest x-ray costs $370 and adds 27 minutes to the ED length of stay. Thus, if x-ray is overused in these indications there might be an opportunity to reduce costs and improve care.

Jane F. Knapp, MD, from the department of pediatrics at Children’s Mercy Hospitals and Clinics in Kansas City, Mo., and colleagues sought to determine trends in x-ray use in ED care of children presenting with asthma, bronchiolitis and croup. They also reviewed links between patient and hospital factors and variation is use.  

The researchers mined National Hospital Ambulatory Medical Care Survey data between 1995 and 2009 on x-ray use in the ED for the following children: ages 2 to 18 years with asthma, ages three months to one year with bronchiolitis and ages three months to six years with croup.

During the study period, there were 6.3 million visits for asthma, 2.8 million visits for bronchiolitis and 4.2 million visits for croup. The use of x-ray for patients with asthma increased over the 15-year span. “[This] trend represented a 2.4-fold increase in the odds use.”

In contrast, there were no significant changes in use for bronchiolitis and croup.

Knapp et al suggested patient/parent expectations may have played a role in the increase. In addition, ED physicians might practice more aggressively because of reduced time to spend with patients, malpractice concerns and clinical performance measures.

They noted that educational programs have curbed unnecessary x-ray use and referred to significantly fewer x-rays ordered for all three indications at pediatric-focused EDs. The researchers proposed evidence-based care guidelines used at pediatric-focused EDs could be disseminated to reduce the use of x-rays at other sites.

“Reversing this trend could improve ED efficiency, decrease costs, and decrease radiation exposure.”