Department of Pediatrics, Children’s Mercy Hospitals and Clinics, University of Missouri–Kansas City, School of Medicine, Kansas City, Missouri 64108, USA.
Pediatrics. 2013 Aug;132(2):245-52. doi: 10.1542/peds.2012-2830. Epub 2013 Jul 22.
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.
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.
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.
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. Pediatric-focused EDs used significantly fewer radiographs for asthma, bronchiolitis, and croup. The translation of practices from pediatric-focused EDs to all EDs could improve performance.
本研究旨在（1）明确在急诊科（ED）治疗哮喘、细支气管炎和喉炎患儿时，X 光片的使用趋势；（2）研究患者和医院因素与 X 光片使用变化之间的关联。
本研究采用回顾性、横断面对比分析，对 1995 年至 2009 年国家医院门诊医疗调查数据进行分析，研究对象为年龄在 2 至 18 岁患有哮喘、3 个月至 1 岁患有细支气管炎和 3 个月至 6 岁患有喉炎的儿童在 ED 就诊时 X 光片的使用情况。计算比值比（OR）并对所有研究因素进行调整。
哮喘患者 X 光片使用率随时间显著增加（OR：1.06；95%置信区间[CI]：1.03-1.09；P <.001 趋势），但细支气管炎和喉炎患者 X 光片使用率无变化。以儿科为重点的 ED 对哮喘（OR：0.44；95% CI：0.29-0.68）、细支气管炎（OR：0.37；95% CI：0.23-0.59）和喉炎（OR：0.34；95% CI：0.17-0.68）的 X 光片使用率较低。与东北地区相比，中西部和南部地区所有 3 种疾病的 X 光片使用率均较高。西部地区仅对哮喘（OR：1.67；95% CI：1.07-2.60）和细支气管炎（OR：2.94；95% CI：1.48-5.87）的 X 光片使用率较高。大都市统计区或医院所有权状况与 X 光片使用率无关。
1995 年至 2009 年，ED 治疗哮喘患儿时 X 光片使用率显著增加。扭转这一趋势可能会带来可观的成本节约和减少辐射。以儿科为重点的 ED 对哮喘、细支气管炎和喉炎患儿的 X 光片使用率明显较低。将儿科重点 ED 的实践推广到所有 ED，可能会提高绩效。
