Radiological Society North America: Approximately 88 percent of pediatric X-rays for chest pain included in a study from Mayo Clinic did not alter clinical treatment. None of the patients who underwent chest X-rays for indications
including fainting, spells, POTS, dizziness or cyclical vomiting had any
finding that affected treatment. Optimizing radiation exposure and cost effectiveness are important
topics in today’s healthcare environment, particularly in a pediatric
population.
Researchers at Mayo Clinic found that some children are receiving
chest X-rays that may be unnecessary and offer no clinical benefit to
the patient, according to a study presented today at the annual meeting
of the Radiological Society of North America (RSNA).
"Chest X-rays can be a valuable exam when ordered for the correct indications," said Ann Packard, M.D., radiologist at the Mayo Clinic in
Rochester, Minn. "However, there are several indications where pediatric
chest X-rays offer no benefit and likely should not be performed to
decrease radiation dose and cost."
Dr. Packard and co-author, Kristen B. Thomas, M.D., head of the
pediatric division at Mayo Clinic and assistant professor of radiology
at Mayo Medical School, reviewed data from 718 pediatric chest X-ray
exams ordered between 2008 and 2014 in Mayo Clinic's inpatient,
outpatient and emergency room settings. The patients undergoing the
exams ranged in age from newborn to 17 years old.
Of the 718 X-ray exams, 377 exams were ordered for chest pain, 98 indicated syncope (fainting)
or presyncope, 21 indicated spells (a general feeling of being unwell or under distress), 37
indicated postural orthostatic hypotension (POTS)—a condition in which blood pressure drops
suddenly when the individual stands up from sitting or lying down, and 185 indicated dizziness.
Eighty-two of the 718 exams were excluded due to congenital or other known heart disease, and
other causes.
The researchers found that in approximately 88 percent of the 330
non-excluded patients who presented with chest pain, the exam did not
alter clinical treatment.
None of the patients who underwent X-rays for indications including syncope, spells, POTS or
dizziness had any finding that affected treatment. Thirty-eight of the 330 non-excluded X-rays for
chest pain were positive for pneumonia, bronchial inflammation, trauma, or other conditions.
"Approximately 12 percent of the chest X-rays for chest pain were
positive and included respiratory symptoms such as cough, fever or
trauma," Dr. Packard said. "There were no positive findings in any chest
X-ray for syncope, dizziness, spells, cyclical vomiting or POTS for the
past five years, even in our tertiary care center with referrals for
rare diseases or unusual presentations."
Optimizing radiation exposure and cost effectiveness are important
topics in today's healthcare environment, particularly in a pediatric
population, Dr. Packard noted.
"This study addresses both of these issues, which is important not
only for physicians but also for young patients and their parents," she
said. "I would like this research to help guide clinicians and deter
them from ordering unnecessary exams which offer no clinical benefit to
the patient."