Recommendations

RACP Paediatrics & Child Health Division

3.
Do not routinely order chest X-rays for the diagnosis of asthma in children

There is extensive evidence that the majority of X-rays ordered for children admitted for asthma and wheezing disorders do not provide clinically relevant information and therefore do not contribute to their diagnosis and management.

Clear clinical criteria outlining the indications for X-rays in asthma should be defined to avoid unwarranted chest X-rays in children with acute wheeze.

Supporting evidence
  • Hederos C-A, Janson S, Andersson H, et al. Chest x-ray investigation in newly discovered asthma. Pediatric Allergy and Immunology 2004; 15(2): 163–165.
  • Muthukrishnan L, Raman R. Analysis of clinical & radiological findings in children with acute wheeze. Pulmonary and Respiratory Research 2013; 1:1
  • Narayanan S, Magruder T, Walley SC, et al. Relevance of chest radiography in pediatric inpatients with asthma. Journal of Asthma 2014; 51(7):751-5.
How this list was made How this list was made

The Paediatrics & Child Health Division (PCHD) formed a group of interested Fellows to comprise a General Paediatrics EVOLVE Working Group. A review of low-value practices relevant to general paediatrics was conducted drawing on lists published by Choosing Wisely US and Canada, contributions to Choosing Wisely Australia by other medical colleges and published EVOLVE lists developed by other specialties in order to identify low-value practices of relevance while avoiding duplicating the mention of practices already identified in other EVOLVE lists. Based on this review, the Working Group shortlisted 15 items for further consideration. 

These 15 items were then reviewed and discussed by participants at a workshop held at the RACP Annual Congress 2016. Following these deliberations, the list was further narrowed down to 10 items. These 10 items were incorporated into an online survey which also summarised the recent evidence on each of these items. A link to the survey was distributed to all Fellows and advanced trainees of the RACP Paediatrics & Child Health Division. 

Survey respondents were asked whether they agreed, disagreed or were unsure about whether each item was undertaken in a significant number of paediatric patients, whether there was good evidence that the item should be undertaken less often and whether reducing use of the item was important in terms of reducing harm and/or costs to the healthcare system. Each item was assigned a score based on respondents’ answers to these three questions on each item. There were 269 respondents representing a survey response rate of approximately 22 per cent. The five highest scoring items were selected to be on this ‘top-five’ list.