The Practice of Obtaining a Chest X-Ray in Pediatric Patients Presenting With Their First Episode of Wheezing in the Emergency Department

Abstract BACKGROUND: At the emergency department, there is a need for an instrument which is quick and easy to use to identify geriatric patients with the highest risk of mortality. The so- called ‘hanging chin sign’, meaning that the mandibula is seen to project over one or more ribs on the chest X-ray, could be such an instrument. This study aims to investigate whether the hanging chin sign is a predictor of mortality in geriatric patients admitted through the emergency department. METHODS: We performed an observational retrospective cohort study in a Dutch teaching hospital. Patients of ≥ 65 years who were admitted to the geriatric ward following an emergency department visit were included. The primary outcome of this study was mortality. Secondary outcomes included the length of admission, discharge destination and the reliability compared to patient-related variables and the APOP screener.RESULTS: 396 patients were included in the analysis. Mean follow up was 300 days; 207 patients (52%) died during follow up. The hanging chin sign was present in 85 patients (21%). Patients with the hanging chin sign have a significantly higher mortality risk during admission (OR 2.94 (1.61 to 5.39), p < 0.001), within 30 days (OR 2.49 (1.44 to 4.31), p = 0.001), within 90 days (OR 2.16 (1.31 to 3.56), p = 0.002) and within end of follow up (OR 2.87 (1.70 to 4.84),p < 0.001). A chest X-ray without a PA view or lateral view was also associated with mortality. This technical detail of the chest x-ray and the hanging chin sign both showed a stronger association with mortality than patient-related variables or the APOP screener. CONCLUSIONS: The hanging chin sign and other details of the chest x-ray were strong predictors of mortality in geriatric patients presenting at the emergency department. Compared to other known predictors, they seem to do even better in predicting mortality.

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Value of Preoperative Chest X-ray Examinations in Children

PEDIATRICS ◽

10.1542/peds.60.5.669 ◽

1977 ◽

Vol 60 (5) ◽

pp. 669-672

Author(s):

Shashikant M. Sane ◽

Robert A. Worsing ◽

Cornelius W. Wiens ◽

Rajiv K. Sharma

Keyword(s):

Prospective Study ◽

Pediatric Patients ◽

Anesthetic Technique ◽

Chest Film ◽

X Ray ◽

Patients Âgés ◽

Chest X Ray ◽

A Prospective Study ◽

Preoperative Chest

To assess the value of routine preoperative chest x-ray films in pediatric patients, a prospective study of 1,500 patients, ages newborn to 19 years, was undertaken. Of all the patients, 7.5% demonstrated at least one roentgenographic abnormality, with 4.7% of the patients demonstrating a totally unsuspected significant roentgenographic anomaly. In 3.8% of the patients, surgery was either postponed or cancelled or the anesthetic technique was altered as a result of the roentgenographic finding. It is believed that the routine preoperative chest film is justified if the film is evaluated before surgery and the results clinically followed up.

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Suggests More Tests for Chest Pain Diagnosis

PEDIATRICS ◽

10.1542/peds.61.1.143b ◽

1978 ◽

Vol 61 (1) ◽

pp. 143-144

Author(s):

Michael F. Elmore ◽

Glen A. Lehman

Keyword(s):

Chest Pain ◽

Physical Examination ◽

Pediatric Patients ◽

Laboratory Studies ◽

Psychiatric Interview ◽

X Ray ◽

Pain Diagnosis ◽

Chest X Ray ◽

Pain Characteristics ◽

Diagnostic Work

Driscoll et al. (Pediatrics 57:648, May 1976) reported a series of 43 patients with chest pain evaluated by history and physical examination, psychiatric interview, screening laboratory studies, ECG, and chest x-ray film. No organic cause was identified in 45% of patients, and various psychiatric aspects of the pain were discussed. The history obtained from pediatric patients is often suboptimal, and specific pain characteristics and associations cannot be defined. We therefore propose that more vigorous diagnostic work-ups are necessary before chest pain can be classed as "idiopathic."

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Chest X-ray Utilization in Febrile Infants 60 Days or Less in the Emergency Department

10.1542/peds.147.3_meetingabstract.275-a ◽

2021 ◽

Author(s):

Erin Bell ◽

Kristen Manto ◽

Giang Ha ◽

Nabeal Aljabban ◽

Lilia Reyes

Keyword(s):

Emergency Department ◽

X Ray ◽

Chest X Ray

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Early clinical predictors of severe acute respiratory syndrome in the emergency department

CJEM ◽

10.1017/s148180350000885x ◽

2004 ◽

Vol 6 (01) ◽

pp. 12-21 ◽

Cited By ~ 2

Author(s):

W.N. Wong ◽

Antonio C.H. Sek ◽

Rick F.L. Lau ◽

K.M. Li ◽

Joe K.S. Leung ◽

...

Keyword(s):

Emergency Department ◽

Severe Acute Respiratory Syndrome ◽

Lymphocyte Count ◽

Case Definition ◽

World Health ◽

Clinical Predictors ◽

X Ray ◽

Abnormal Chest ◽

Contact Exposure ◽

Chest X Ray

ABSTRACT Objectives: To assess the association of diagnostic predictors available in the emergency department (ED) with the outcome diagnosis of severe acute respiratory syndrome (SARS). Methods: This retrospective cohort study describes all patients from the Amoy Garden complex who presented to an ED SARS screening clinic during a 2-month outbreak. Clinical and diagnostic predictors were recorded, along with ED diagnoses. Final diagnoses were established independently based on diagnostic tests performed after the ED visit. Associations of key predictors with the final diagnosis of SARS were described. Results: Of 821 patients, 205 had confirmed SARS, 35 undetermined SARS and 581 non-SARS. Multivariable logistic regression showed that the strongest predictors of SARS were abnormal chest x-ray (odds ratio [OR] = 17.4), subjective fever (OR = 9.7), temperature >38°C (OR = 6.4), myalgias (OR = 5.5), chills and rigors (OR = 4.0) and contact exposure (OR = 2.6). In a subset of 176 patients who had a complete blood cell count performed, the strongest predictors were temperature ≥38ºC (OR = 15.5), lymphocyte count <1000 (OR = 9.3) and abnormal chest x-ray (OR = 5.7). Diarrhea was a powerful negative predictor (OR = 0.03) of SARS. Conclusions: Two components of the World Health Organization case definition — fever and contact exposure — are helpful for ED decision-making, but respiratory symptoms do not discriminate well between SARS and non-SARS. Emergency physicians should consider the presence of diarrhea, chest x-ray findings, the absolute lymphocyte count and the platelet count as significant modifiers of disease likelihood. Prospective validation of these findings in other clinical settings is desirable.

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Influenza B Virus-associated Pneumonia in Pediatric Patients: Clinical Features, Laboratory Data, and Chest X-ray Findings

Pediatrics & Neonatology ◽

10.1016/j.pedneo.2013.07.002 ◽

2014 ◽

Vol 55 (1) ◽

pp. 58-64 ◽

Cited By ~ 6

Author(s):

Chi-Yu Liu ◽

Jiaan-Der Wang ◽

Jen-Ta Yu ◽

Li-Ching Wang ◽

Ming-Chih Lin ◽

...

Keyword(s):

Clinical Features ◽

Pediatric Patients ◽

Laboratory Data ◽

Influenza B Virus ◽

Influenza B ◽

X Ray ◽

B Virus ◽

Chest X Ray

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Simple Pneumonia or Something More?: A Case Report and Discussion of Unexpected Empyema Identified by Point-of-Care Ultrasound

CJEM ◽

10.1017/cem.2015.71 ◽

2015 ◽

Vol 18 (5) ◽

pp. 391-394

Author(s):

Michael Romano ◽

Tomislav Jelic ◽

Jordan Chenkin

Keyword(s):

Emergency Department ◽

Point Of Care ◽

Fluid Collection ◽

Chest Ct ◽

Point Of Care Ultrasound ◽

X Ray ◽

Level Of Consciousness ◽

Chest X Ray ◽

Ultrasound Assessment ◽

Higher Sensitivity

AbstractThere is evidence to suggest that point-of-care ultrasound assessment of the lungs has a higher sensitivity and specificity than chest radiography for the diagnosis of pneumonia. It is unknown if the same is true for pneumonia complications. We present and discuss the case of a 61-year-old woman who presented to the emergency department with confusion, decreased level of consciousness, and signs of sepsis. A chest x-ray revealed a right sided infiltrate. An ultrasound of the patient’s lungs was performed, and revealed a complex loculated fluid collection consistent with an empyema. A chest CT confirmed the diagnosis, and immediate percutaneous drainage was performed.

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Aurea diagnosis of pneumomediastinum. A case report

Italian Journal of Medicine ◽

10.4081/itjm.2020.1292 ◽

2020 ◽

Vol 14 (3) ◽

pp. 179-183

Author(s):

Lucio Brugioni ◽

Francesca De Niederhausern ◽

Chiara Gozzi ◽

Pietro Martella ◽

Elisa Romagnoli ◽

...

Keyword(s):

Emergency Department ◽

Case Report ◽

Chest Pain ◽

Correct Diagnosis ◽

Young Male ◽

Differential Diagnoses ◽

Diagnostic Process ◽

Acute Aortic Syndrome ◽

X Ray ◽

Chest X Ray

Pericarditis and spontaneous pneumomediastinum are among the pathologies that are in differential diagnoses when a patient describes dorsal irradiated chest pain: if the patient is young, male, and long-limbed, it is necessary to exclude an acute aortic syndrome firstly. We present the case of a young man who arrived at the Emergency Department for chest pain: an echocardiogram performed an immediate diagnosis of pericarditis. However, if the patient had performed a chest X-ray, this would have enabled the observation of pneumomediastinum, allowing a correct diagnosis of pneumomediastinum and treatment. The purpose of this report is to highlight the importance of the diagnostic process.

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