When Are X-Rays Too Much Care?

X ray use in children with asthma has climbed in recent years in emergency rooms

(RxWiki News) One of the first things doctors need to do to treat a child in the emergency room is determine what the problem is. Chest X-rays are one way to spot the problem for kids with lung conditions.

But x-rays are not needed for all children who come to the ER with respiratory problems such as asthma.

Even so, a recent study found the use of x-rays for children with asthma in the ER has been increasing.

It's not clear why x-ray use has increased, but decreasing it would mean less radiation exposure for children and lower costs, the study authors said.

"Ask your child's doctors to explain treatment options."

This study, led by Jane F. Knapp, MD, of Children's Mercy Hospitals and Clinics in Kansas City, Missouri, aimed to learn more about how x-rays and other imaging tests were used in emergency rooms.

The study focused specifically on how imaging is used for children with asthma, bronchiolitis and croup (a loud cough).

The researchers analyzed the data for the years 1995 to 2009 in the National Hospital Ambulatory Medical Care Survey.

The analysis included visits for children aged 2 to 18 who came to the emergency room with asthma, children aged 3 months to 1 year who had bronchiolitis and children aged 3 months to 6 years who had croup.

The use of x-rays for children with asthma increased over the time span studied.

The increase from one year to the next was small — about 7 percent. But over the full time span, the use of x-rays for children with moderate to severe asthma increased by 2.4 times.

Meanwhile, the use of x-rays for children with bronchiolitis or croup did not change over the time studied.

When the researchers compared x-ray use at emergency rooms that specialized in pediatrics to the use of x-rays at regular emergency rooms, they found the pediatric ERs used x-rays less often.

Pediatric emergency rooms used x-rays for asthma about half as often as general ERs.

Pediatric ERs used x-rays about a third as much as general ERs for bronchiolitis and croup.

It's not clear why the increase in x-ray use for asthma occurred. There had been no updates or changes to guidelines for the use of x-rays during this time.

Also, the Centers for Disease Control and Prevention (CDC) data does not show childhood asthma severity increased over this time span.

Further, both ER visits and hospitalizations for childhood asthma, as well as asthma attacks, remained steady during this time. The only change was the increase in x-ray use.

The researchers suggested that parents' expectations of doctors might be related to the increased use of x-rays.

In addition, doctors might feel pressures to use more "aggressive" care for various reasons, such as concerns about performance reviews, malpractice and too little time available to spend with patients.

Whatever the cause, reducing the use of x-rays for children who have asthma may have benefits, the authors wrote.

"Reversing this trend could improve emergency department efficiency, decrease costs and decrease radiation exposure," the authors wrote.

One way parents can help in preventing their children from being unnecessarily x-rayed is to speak up, suggested Chris Galloway, MD, a dailyRx expert who specializes in emergency medicine.

"Ask if that x-ray is absolutely necessary," Dr. Galloway said. "Evidence-based medicine often says it is not, particularly in some common pediatric respiratory complaints."

He said many emergency rooms now have specific protocols they follow before a patient may even see a doctor.

"These are based on the chief complaint of the patient and can occur before even seeing the physician, but you can always object or ask to hold until you see the physician," Dr. Galloway said.

"We always want to err on the side of caution, but basic asthma exacerbations do not need an x-ray unless we run into treatment failures in the ER," he said. "A croupy cough is a diagnosis often made from across the room with your ears as long as there is no history or concern of foreign body aspiration."

This study was published July 22 in the journal Pediatrics.

The research did not use external funding, and the authors declared no conflicts of interest.

Review Date: 
July 25, 2013