title: Variation and trends in ED use of radiographs for asthma, bronchiolitis, and croup in children.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Pediatrics, Children’s Mercy Hospitals and Clinics, University of Missouri–Kansas City, School of Medicine, Kansas City, Missouri 64108, USA. jknapp@cmh.edu
authors.forename: Jane F
authors.initials: JF
authors.lastname: Knapp
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Simon
authors.forename: Vidya
authors.initials: V
authors.lastname: Sharma
mesh_terms: D000293:Adolescent; D000318:Adrenergic beta-Agonists / Q000008:administration & dosage; D001249:Asthma / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D001988:Bronchiolitis / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D001993:Bronchodilator Agents / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies / Q000706:statistics & numerical data; D003440:Croup / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data* / Q000639:trends*; D005260:Female; D006302:Health Services Research / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008297:Male; D011859:Radiography / Q000706:statistics & numerical data* / Q000639:trends*; D014218:Triage / Q000706:statistics & numerical data / Q000639:trends; D014481:United States; D014600:Utilization Review / Q000706:statistics & numerical data / Q000639:trends
chemical_list: D000318:Adrenergic beta-Agonists; D001993:Bronchodilator Agents
keywords: asthma; bronchiolitis; croup; emergency department; measures; pediatric; performance indicators; quality; radiograph; trends; variation