哮喘联盟

   摘要
   简介：该研究的目的在于判断影响急性哮喘加重的住院患儿预约胸片拍摄（CXR's）的影响因素，评估CXR's总的临床影响。
   方法：一项回顾性研究，于2011年6月1日至2012年5月31日间，纳入在急诊科，确诊为急性哮喘发作或哮喘持续状态的2岁以上患儿。排除在急诊科就诊前使用抗生素，住院期间接受持续沙丁胺醇或静脉镁注射或其他慢性疾病影响肺功能的患者。
   结果：405例患儿中有180例（44%）拍摄了CXR's，其中18例（10%）的影像结果改变了患者的治疗方案。6例经放射科诊断为肺炎，9例为经抗生素治疗的肺不张和3例气胸。与拍摄胸片相关的因素包括：家中或ED发热（OR 4.5，95% CI 2.8-7.4）、氧饱和度≤92% （OR 1.8，95% CI 1.2-2.7）、年龄4 岁或更小（OR 2.3，95% CI 1.4-3.7）。因CXR's改变治疗的患者更有可能氧饱和＜或＝92%（OR 4.2，95% CI 1.4-13.0； p=0.006） 或在ED发热（OR 3.8，95% CI 1.0-13.6，p<0.05）。因CXR改变治疗的患者氧饱和度均不超过96%。
   结论：在哮喘加重的儿科住院患者中，预约CXR's在大多数患儿不能提供相关的临床信息。
 

（刘国梁 审校）
J Asthma. 2014 Mar 27. [Epub ahead of print]

 

Relevance of Chest Radiography in Pediatric Inpatients with Asthma.
 

Narayanan S1, Magruder T, Walley SC, Powers T, Wall TC.
 

ABSTRACT
INTRODUCTION: The goals of this study are to identify factors associated with ordering of chest radiographs (CXR's) in children hospitalized with acute asthma exacerbations and determine the overall clinical impact of these CXR's.
METHODS: A retrospective study was performed with children ≥2 years of age admitted from our emergency department (ED) between 6/1/2011 and 5/31/2012 with a primary diagnosis of acute asthma exacerbation or status asthmaticus. Patients were excluded if they had been on antibiotics prior to the emergency visit, received continuous albuterol or intravenous magnesium during the hospitalization, or had another chronic disease affecting lung function.
RESULTS: 180 of the 405 children in the study (44%) had CXR's ordered, of which 18 (10%) had imaging that altered the patient's treatment plan. There were 6 cases of radiologist-diagnosed pneumonia, 9 cases of atelectasis treated with antibiotics, and 3 cases of pneumothorax. Factors associated with CXR ordering were: fever at home or in the ED (OR 4.5, 95% CI 2.8-7.4), triage oxygen saturation less than or equal to 92% (OR 1.8, 95% CI 1.2-2.7), and age 4 years or less (OR 2.3, 95% CI 1.4-3.7). Patients with treatment-altering CXR's were more likely to have oxygen saturations less than or equal to 92% (OR 4.2, 95% CI 1.4-13.0; p=0.006) or fever in the ED (OR 3.8, 95% CI 1.0-13.6, p<0.05). No patients with triage oxygen saturation above 96% had a treatment-altering CXR.
CONCLUSIONS: The majority of CXR's ordered in pediatric inpatients with asthma exacerbation do not provide clinically relevant information.
 

J Asthma. 2014 Mar 27. [Epub ahead of print]