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Retrospective Analysis of Utility of Postbronchoscopy Chest Roentgenograms in the Pediatric Population FREE TO VIEW

Nicholas Mulhearn, DO; Mark Minor, MD; Kevin Maupin, MD; Stephanie Thompson, PhD
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Charleston Area Medical Center, Charleston, WV

Chest. 2014;146(4_MeetingAbstracts):550A. doi:10.1378/chest.1993601
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SESSION TITLE: Cost and Quality Improvement Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Flexible fiberoptic bronchoscopy (FFB) is the leading modality for diagnosing lower respiratory tract diseases. In pediatrics, the indications for bronchoscopy are numerous and include, but are not limited to: suspected birth defects, stridor, persistent wheezing and coughing, and recurrent lung infections. FFB has a low incidence of morbidity and mortality. Complication rates from FFB in pediatrics vary between studies, ranging from 2-23%. Pneumothorax is reported in most series, having an incidence of 0 to 5%. Routine post bronchoscopy care in adults is well established and current recommendations for obtaining a chest roentogram (x-ray) status post procedure are generally only indicated if a biopsy was performed or if symptoms are of concern. Despite evidence in pediatrics demonstrating a low incidence of major complications, many clinicians still obtain post-bronchoscopy chest x-rays in all patients. At our institution, it is routine practice to obtain a chest x-ray after bronchoscopy in all pediatric patients. Currently, there is no literature to support or disprove this practice.

METHODS: All bronchoscopies performed at our pediatric institution through a 2 year period (June 2011-June2013) were analyzed. Retrospectively, a review was performed on charts of patients 18 years or younger that underwent FFB as indicated by ICD-9 codes.

RESULTS: Of the charts reviewed 252 FFB’s were performed on a total of 241 patients. The mean age of patients was 7.3 (+- 5.7). Of the 252 bronchoscopies performed, 209 had chest x-rays following bronchoscopy. Six (2.9%) chest x-rays altered patient care. Of those six, three patients showed false positive findings which resulted in further imaging. Of the three false positives, two cases were admitted and managed supportively without further intervention. Chi-squared statistical analysis was performed to determine if there was a relationship between complications during or after bronchoscopy and post-bronchoscopy x-ray abnormalities. There was no statistical significance with values of 0.121 and 0.140 respectively.

CONCLUSIONS: These results demonstrate that performing routine chest x-rays after bronchoscopy is not warranted unless clinical symptoms dictate further imaging.

CLINICAL IMPLICATIONS: The review demonstrated that post-bronchoscopy x-ray findings can negatively impact the patient by exposure to further radiation, hospitalization and cost. There was no benefit gained for patients with routine post-bronchoscopy x-ray.

DISCLOSURE: The following authors have nothing to disclose: Nicholas Mulhearn, Mark Minor, Kevin Maupin, Stephanie Thompson

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