Chest radiography in the initial episode of bronchospasm in children: can clinical variables predict pathologic findings?
OBJECTIVE
To determine whether historical or clinical variables can accurately discriminate among children, experiencing a first episode of bronchospasm, with chest radiography findings that are normal, consistent with reactive airway disease (RAD), or pathologic.


METHODS
We assembled a prospective case series of patients in our tertiary, academic, pediatric emergency department. All patients aged newborn to 18 years presenting to the ED with their initial episode of wheezing were enrolled.


RESULTS
Six hundred thirty-three patients presented to the ED during the study period. Pathologic radiographic findings were identified in 39 (6.2%). Radiographs revealing normal findings and evidence of RAD were noted in 25.4% and 68%, respectively. No single variable accurately predicted all pathologic radiographs. Discriminant function analysis identified nine variables, which we combined into a model. The model failed to accurately discriminate among patients with radiographs revealing evidence of a pathologic condition, normal chest findings, and RAD.


CONCLUSIONS
No clinical variables, isolated or combined into a model, accurately identify patients with pathologic radiography findings. Continued use of chest radiography as a diagnostic intervention in the initial episode of childhood bronchospasm is recommended.
Walsh-Kelly
C M
CM
Department of Pediatrics, Medical College of Wisconsin, Milwaukee, USA.
Kim
M K
MK
Hennes
H M
HM
D000293:Adolescent; D001249:Asthma / Q000235:genetics; D001986:Bronchial Spasm / Q000150:complications / Q000000981:diagnostic imaging*; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D003371:Cough / Q000209:etiology; D016002:Discriminant Analysis; D004485:Eczema / Q000235:genetics; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008168:Lung / Q000000981:diagnostic imaging*; D008297:Male; D010092:Oximetry; D011859:Radiography; D012135:Respiratory Sounds / Q000209:etiology; D012307:Risk Factors