801 Evaluating the use of chest radiographs in a paediatric emergency department
Collicott, Nathan Perry, Sophie Begley, Roisin
Collicott, Nathan
Perry, Sophie
Begley, Roisin
Glos Author
Date
2021-09-30
Journal Title
Type
Conference Abstract
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Abstract
Abstract
Background Requests for chest radiographs in children attending the Bristol Royal Hospital for Children (BRHC) ED were noted to be increasing 2017–2019, with predictable winter peaks, particularly in November. Previous work questions the utility of chest radiographs and their impact on management of common paediatric presentations to ED, including LRTI, bronchiolitis and wheeze.
Objectives To describe the patient cohort undergoing chest radiographs in a paediatric ED within a tertiary children’s hospital in terms of age, indication and final ED diagnosis.
To quantify the proportion of abnormal (‘positive’) and normal (‘negative’) chest radiographs, as reported by radiologists, with respect to indication and age.
To quantify the proportion of patients undergoing a chest radiograph receiving antibiotics and whether these were prescribed before or after imaging.
Methods Retrospective review of patients who attended the BRHC Paediatric ED undergoing chest radiograph in the first two weeks of November 2017–2019. Data for age (split into 0–11 months, 1–4y, 5–10y and 11+ groups), indication for radiograph, the final coded ED diagnosis, radiograph findings and antibiotic treatment were collected.
Results The 1–4y age group represented the largest proportion of radiographs, accounting for 53% of all requests.
Table 1 shows the five most common indications are shown below. CAP/LRTI was the most common indication in all age groups, accounting for 55% of total requests.
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Abstract 801 Table 1
Stated indications
The five most common final coded diagnoses are shown below. URTI and bronchiolitis are commonly coded discharge diagnoses in this cohort.
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Abstract 801 Table 2
Discharge diagnoses
Over three years, 302 chest radiograph requests were made. Across all groups, 67% were reported as normal. In the 0–1y age group, 83% of radiographs were normal.
135 patients received antibiotics; 62% were prescribed after chest radiograph.
Conclusions Our data shows that use of chest x-rays has steadily increased over the studied period. Although BTS guidelines suggest relatively limited indications for chest x-rays in the setting of CAP in children, this remains the most common reason given for our patients to undergo a chest radiograph. Importantly, a significant majority of x-rays were reported as normal, especially among infants.
Targeting chest radiographs more effectively may be helpful for several reasons. Firstly, there is limited evidence that they are helpful in distinguishing bacterial pneumonia from other aetiologies. Although the retrospective nature of our data poses challenges, it suggests that clinicians tend to make antibiotic treatment decisions at least partly based on x-ray findings. Secondly, all other things being equal, a patient undergoing x-ray will spend longer in ED than one who does not. This potentially has an impact on patient flow, even more important with the current need for social distancing.
We plan to use this data as a baseline for future quality improvement work with the aim of reducing chest X-ray use in patients unlikely to benefit.
Citation
Collicott, N., Perry, S., & Begley, R. (2021). Evaluating the use of chest radiographs in a paediatric emergency department. Archives of Disease in Childhood, 106(Suppl 1), A119–A120.
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