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QI TO DECREASE UNNECESSARY CHEST X-RAY
IN ACUTE ASTHMA EXACERBATION IN CHILDREN 2–18 YEARS
QI TO DECREASE UNNECESSARY CHEST X-RAY...
INCLUSION CRITERIA

• Children age 2–18 years
• Established asthma diagnosis
• Presentation consistent with acute asthma exacerbation
INCLUSION CRITERIA...
EXCLUSION CRITERIA

• Comorbidities: sickle cell disease, congenital heart disease,
  immunodeficiency, BPD, severe malnutrition
• First-time wheezing unrelated to prior asthma diagnosis
EXCLUSION CRITERIA...
⚑ Other conditions where CXR is required:

•Physical findings suggestive of pneumonia or parenchymal disease
(focal crackles, dullness, fever)
•Suspicion of inhaled foreign body
(sudden onset, unilateral decreased breath sounds)
•Suspicion of structural complications
(pneumothorax, pneumomediastinum)
•Trauma, post-op
⚑ Other conditions where CXR is required:...
DO NOT ROUTINELY OBTAIN CHEST X-RAY
in typical / uncomplicated asthma exacerbation
DO NOT ROUTINELY OBTAIN CHEST X-RAY...
CONSIDER OBTAINING CXR IF:
CONSIDER OBTAINING CXR IF:
OR
OR
Severe Respiratory Distress
Respiratory Score 7–12
Severe Respiratory Distress...
Inadequate Response After ≥ 2 Hours
of Routine Asthma Exacerbation Management
WITH any of the following:
Inadequate Response After ≥ 2 Hours...
Past Medical
History
Past Medical...
1. History of recurrent pneumonia
2. History of pneumothorax
1. History of recurrent pneumonia...
RR > 40*
RR > 40*
2–5 years of age
2–5 years of age
RR > 30*
RR > 30*
6–8 years of age
6–8 years of age
RR > 20*
RR > 20*
9–18 years of age
9–18 years of age
Pulse Oximetry
Pulse Oximetry
Lowest SpO₂ <91% on room air*
OR required inhaled FiO₂ >50% to keep saturations >90%
* after 2 hours of routine management
Lowest SpO₂ <91% on room air*...
Lung Exam
Lung Exam
Localizing findings or asymmetry on lung examination
Localizing findings or asymmetry on lung examination
→ OBTAIN CHEST X-RAY
→ OBTAIN CHEST X-RAY
* Respiratory rate thresholds apply after ≥ 2 hours of routine asthma exacerbation management
* Respiratory rate thresholds apply after ≥ 2 hours of routine asthma exacerbation mana... \ No newline at end of file