The Practice of Obtaining a Chest X-Ray in Pediatric Patients Presenting With Their First Episode of Wheezing in the Emergency Department
| Autor: | Ameer Hassoun, Nishit Patel, Jennifer H. Chao |
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| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty MEDLINE Unnecessary Procedures 03 medical and health sciences 0302 clinical medicine Pediatric emergency medicine Surveys and Questionnaires 030225 pediatrics Medical Staff Hospital medicine Humans Practice Patterns Physicians' Child Lung Fellowship training Respiratory Sounds First episode business.industry Internship and Residency 030208 emergency & critical care medicine General Medicine Emergency department Asthma United States Confidence interval Test (assessment) Family medicine Pediatrics Perinatology and Child Health Respondent Emergency Medicine Female Radiography Thoracic Emergency Service Hospital business |
| Zdroj: | Pediatric Emergency Care. 36:16-20 |
| ISSN: | 1535-1815 0749-5161 |
| DOI: | 10.1097/pec.0000000000002015 |
| Popis: | BACKGROUND Routine use of chest X-ray (CXR) in pediatric patients presenting with their first episode of wheezing was recommended by many authors. Although recent studies conclude that a CXR is not routinely indicated in these children, there continues to be reports of overuse. OBJECTIVE To examine the attitudes of practicing physicians in ordering CXRs in pediatric patients presenting with their first episode of wheezing to an emergency department (ED) and the factors that influence this practice by surveying ED physicians. METHODS A survey targeting pediatric emergency medicine (PEM) and general emergency medicine attending physicians was distributed electronically to the nearly 3000 members of the PEM Brown listserve and the Pediatric Section of American College of Emergency Physicians listserve. The 14-item survey included closed ended and free text questions to assess the respondent's demographic characteristics, their belief and current practice of obtaining a CXR in pediatric patients presenting with their first episode of wheezing. Data were analyzed using descriptive statistics and χ test. RESULTS Of the 537 attending physicians who participated, their primary residency training was: 42% pediatrics, 54% emergency medicine, and 4% other. Seventy-two percent of participating physicians supervise residents, 54% were board-eligible or -certified in PEM. Thirty percent (95% confidence interval [CI], 26-34) of participants indicated that they would always obtain a CXR in pediatric patients presenting with their first episode of wheezing. Eighty-one percent (95% CI, 75-87) of those who always obtain a CXR believe that it is the standard of care. Of the 376 physicians who do not always obtain a CXR, 18% (95% CI, 15-23) always obtain a CXR under certain age (2 weeks to 12 years, median of 1 year). Physicians who report a primary residency in pediatrics, who supervise residents, who were board-eligible or -certified in PEM, and who were practicing for greater than 5 years were less likely to obtain a CXR (P < 0.001, P < 0.001, P < 0.001, P = 0.001). CONCLUSIONS In our study, a significant number of practicing ED physicians routinely obtain a CXR in children with their first episode of wheezing presenting to the ED. The factors influencing this practice are primary residency training, fellowship training, resident supervision, and years of independent practice. This identifies a target audience that would benefit from education to decrease the overuse of CXRs in children with wheezing. |
| Databáze: | OpenAIRE |
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