CHICAGO - Most x-rays performed on children not experiencing chest pain may be unnecessary, concluded researchers from the Mayo Clinic, who presented their findings on Wednesday at RSNA 2014.
In fact, when they examined x-rays done for fainting complaints, dizziness, postural orthostatic tachycardia syndrome (POTS), or a general feeling of unease, they found that none of the scans changed any treatment plans.
Even most x-rays performed on children who have chest pain fail to change treatment plans, said Dr. Ann Packard, a resident at the Mayo Clinic in Rochester, MN. She and her colleagues determined that 88% of the x-rays performed for chest pain in children did not alter planned treatment.
Dr. Ann Packard from the Mayo Clinic."Chest x-rays are a very common but sometimes overperformed exam," she said at a press conference at the meeting. "Our study shows that a majority of x-rays ordered in children for certain problems may not be necessary."
The researchers studied 718 radiographs performed in children as young as newborns and up to 17 years old. For those with chest pain complaints, 377 tests were ordered; in addition, 185 exams were performed for dizziness, 98 were performed for fainting, 37 were done with POTS as the chief complaint, and 21 were performed in patients who exhibited a general feeling of unease.
Radiologists who did not know the patient's clinical information reviewed the x-rays, and the findings were compared with a limited review of each child's medical record to determine if the x-ray changed treatment.
Packard said the study excluded children with a history of heart disease, those who were intubated, those who recently underwent surgery, and those who were already being treated when the x-ray scan was ordered.
Of the 377 patients with chest pain, 38 of the x-ray findings contributed to a change in treatment, including 17 patients with pneumonia, five of whom had fever. X-rays ordered for chest pain were positive approximately 12% of the time, Packard noted.
"I don't know if it's just historical to do x-ray exams in children for syncope or dizziness, or if no one has taken the time to look back to see if there is any reason to do those exams," she told AuntMinnie.com.
Moderator Dr. Salomao Faintuch from Harvard Medical School."Chest x-rays for syncope/fainting, dizziness, spells, and POTS offer no benefit to children," she said. The next step in the study is to try to educate physicians in an attempt to reduce costs -- and radiation exposure.
"A chest x-ray may be more beneficial if the child has fever or trauma," she added.
The researchers plan to continue tracking ordering practices and communicating the results of the study to physicians who treat children. "We are in the process of discussing these findings with our ordering staff," she said.
"There is a tremendous emphasis now on looking into the value of radiology services," said Dr. Salomao Faintuch, an assistant professor of radiology at Harvard Medical School, who commented on the study as moderator of the press conference. "The findings are really interesting in that for certain conditions chest x-rays should not be ordered, because we are not helping our patients in any way by doing those exams."
"There is no question that these data are compelling enough to change clinical practice," he told AuntMinnie.com.
