Abnormal chest roentgenograms have been reported in 43 to 76 percent of children who are hospitalized with asthma (read everything about Childhood Asthma). When the roentgenograms reported to show only “hyperaeration” or “emphysematous changes” are excluded, the frequency of abnormal findings is still one in four. This has resulted in the recommendation that a chest x-ray examination be a part of the evaluation of any patient admitted to the hospital with asthma. The purpose of this investigation was to assess the incidence of roentgenographic abnormalities which might alter the management of children admitted to the hospital in status asthmaticus and to determine whether these abnormalities could be predicted from the history or physical examination.
Patient Population and Methods
All children who were admitted to the Childrens Hospital of Buffalo from January 1, 1980 through May 15, 1980 because of acute asthma unresponsive to emergency room treatment were admitted to the study. During the study period, 614 children presented to the emergency room with asthma. One hundred twenty-nine children were admitted, including one patient who was admitted twice.
Admission was based upon failure to significantly improve following administration of two doses of subcutaneous epinephrine (1:000, 0.01 ml/kg) followed by nebulized iso-etharine and intravenous aminophylline (5-6 mgAg).
The admitting house officer, who was a second or third year pediatric resident, was asked to evaluate each patient clinically using the scoring system of Wood et al. This score examines arterial oxygen tension (Po2), cyanosis, degree of wheezing, character of breath sounds, use of accessory muscles of respiration, and cerebral function. The resident was also asked to record his plan for care prior to looking at an x-ray film, and whether or not he thought the patient had pneumonia, pneumothorax, pneumomediastinum, or any roentgenographic abnormality other than hyperinflation. The patients’ charts were reviewed by one of us (LJB) before their discharge from the hospital to gather data and to determine whether the treatment plan (outlined before the x-ray film was taken) was altered once the roentgenographic findings were known.
All roentgenograms were reviewed without knowledge of the clinical findings by one of the investigators (EA), who is a full-time pediatric radiologist The chest was considered hyperinflated when the diaphragms were low and flat with a horizontal position of the ribs and an increased anterior-posterior diameter with an increased retrosternal space. Peribronchial thickening was recorded if characteristic “tram lines” or thick-walled circular bronchi were noted. The films were carefully evaluated for evidence of pneumothorax or pneumomediastinum, and an attempt was made to differentiate pneumonia from atelectasis. An infiltrate with apparent loss of volume and without pleural fluid and with a distribution corresponding to a lobe or bronchopulmonary segment was called atelectasis. When differentiation from pneumonia was impossible, the infiltrate was reported as “possible pneumonia.”
Statistical analysis was performed using the chi-square method or analysis of variance.