PEM Pearls

The preschool child presenting with wheeze is unlikely to have pneumonia

Wheeze is one of the most common presenting complaints in preschool aged children. These children are often febrile and have increased work of breathing at presentation, so there can be an urge to order a chest x-ray to exclude a bacterial pneumonia.

Several studies have shown that chest x-rays in this population rarely change management and that radiographic pneumonia is uncommon amongst preschool aged children who present with wheeze.

To put some numbers to it, one study of 526 patients who presented with wheeze and went on to have a chest x-ray found that only 4.9% (26 patients) had radiographic evidence of pneumonia. In afebrile children, this rate dropped to just 2.2%.
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Some children will require a chest x-ray; for example, those with chronic cardiorespiratory disease, immunocompromise, a history suggestive of foreign body aspiration or severe disease. However, in the otherwise well preschooler, think carefully before you hit the ‘order chest x-ray’ button.

Dr. Danielle Scarfe