Roback M G, Dreitlein D A
Division of Emergency Medicine, Children's Hospital, University of Colorado Health Sciences Center, Denver 80218, USA.
Pediatr Emerg Care. 1998 Jun;14(3):181-4. doi: 10.1097/00006565-199806000-00001.
To evaluate the current clinical use and utility of chest radiographs (CXR) in the workup of pediatric patients with first time wheezing (FTW) episodes.
Urban children's hospital.
Retrospective review of medical records of patients seen in the emergency department in 1994 with disposition diagnoses of asthma or reactive airways disease, bronchiolitis, pneumonia, congenital heart disease, congestive heart failure, or foreign body aspiration to identify those patients presenting with FTW episodes.
Clinical findings in FTW were compared in patients receiving a CXR (121, 41%) and those who did not (177, 59%). Comparisons were made between patients with a clinically significant CXR (CXR-pos) (29, 24%) and those without (92, 76%). CXR-pos was defined as a CXR result which would be expected to alter patient management. Comparisons between groups were analyzed using the two-tailed Student's t test for continuous variables and the chi2 statistic for categorical data. The level of significance was determined at P < 0.05.
Two hundred ninety-eight episodes of FTW were identified of 1984 patient charts reviewed. Patients receiving CXR differed from those who did not by being of a greater age (39 vs 20 months, P < 0.01), having lower pulse oximetry (89.7 vs. 92.7%, P < 0.01), being less likely to have a family history of asthma (47.5 vs 63.2%, P < 0.01), or history of atopy (40.6 vs 59.4%, P < 0.01). Those with localized wheezes (59.4 vs 40.6% P < 0.01), localized rales (59.3 vs 40.7 % P < 0.01), and localized decreased breath sounds (59.3 vs 40.7%, P = 0.01) were also more likely to receive a CXR. Among patients receiving CXR, clinical characteristics associated with CXR-pos were elevated temperature (37.9 vs 37.5 degrees C, P = 0.04), absence of family history of asthma 72.6 vs 27.4%, P < 0.01), and the presence of localized wheezes (76.0 vs 24.0%, P = 0.02), or localized rales (76.0 vs 24.0%, P < 0.01).
Clinicians in this setting do not routinely obtain a CXR in patients with FTW episodes. Retrospective examination of clinician practice revealed several clinical characteristics that were associated with increased use of CXR in FTW. Increased utility of the CXR was associated with patients having elevated temperature, an absence of a family history of asthma, and localized wheezes or rales by ausculatory examination.
评估胸部X光片（CXR）在首次喘息（FTW）发作的儿科患者检查中的当前临床应用及效用。
城市儿童医院。
回顾性审查1994年在急诊科就诊的患者病历，这些患者的处置诊断为哮喘或反应性气道疾病、细支气管炎、肺炎、先天性心脏病、充血性心力衰竭或异物吸入，以确定那些出现FTW发作的患者。
比较接受CXR检查的患者（121例，41%）和未接受CXR检查的患者（177例，59%）的FTW临床发现。对具有临床意义的CXR（CXR阳性）患者（29例，24%）和无临床意义的患者（92例，76%）进行比较。CXR阳性定义为预期会改变患者管理的CXR结果。使用双尾学生t检验分析连续变量组间差异，使用卡方统计分析分类数据组间差异。显著性水平设定为P < 0.05。
在审查的1984份患者病历中，共识别出298次FTW发作。接受CXR检查的患者与未接受检查的患者不同，前者年龄更大（39个月对20个月，P < 0.01），脉搏血氧饱和度更低（89.7%对92.7%，P < 0.01），哮喘家族史的可能性更小（47.5%对63.2%，P < 0.01），特应性病史的可能性更小（40.6%对59.4%，P < 0.01）。有局限性哮鸣音（59.4%对40.6%，P < 0.01）、局限性湿啰音（59.3%对40.7%，P < 0.01）和局限性呼吸音减弱（59.3%对40.7%，P = 0.01）的患者也更有可能接受CXR检查。在接受CXR检查的患者中，与CXR阳性相关的临床特征包括体温升高（37.9摄氏度对37.5摄氏度，P = 0.04）、无哮喘家族史（72.6%对27.4%，P < 0.01）以及存在局限性哮鸣音（76.0%对24.0%，P = 0.02）或局限性湿啰音（76.0%对24.0%，P < 0.01）。
在此环境下，临床医生对FTW发作患者通常不常规进行CXR检查。对临床医生实践的回顾性检查揭示了FTW发作中与增加CXR使用相关的几个临床特征。CXR效用增加与体温升高、无哮喘家族史以及听诊检查发现局限性哮鸣音或湿啰音的患者有关。
