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Chest X-rays: Learning forbearance

"Round" pneumonia in a 15-year-old with cough and fever. (Image: Nevit Dilmen/Wikimedia Commons)

In emergency situations involving children, it’s tempting for doctors to do everything possible to get information, especially when anxious parents are at hand. Unfortunately, that can mean a lot of unnecessary imaging and radiation exposure, and sometimes fruitless exploratory surgery.

This has spurred a search for biomarkers that can reliably make or rule out a diagnosis, as in appendicitis, and the creation of decision rules about the need for imaging, as in minor head trauma and blunt abdominal trauma, based on physical examination and limited testing, and validated by a large volume of clinical experience.

Emergency physicians Mark Neuman and Rich Bachur at Children’s Hospital Boston have been looking to reduce the use of chest X-rays in children with suspected pneumonia, where chest X-ray is usually considered the diagnostic testing modality of choice.

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