Utility of Chest Radiographs in Children Presenting to a Pediatric Emergency Department With Acute Asthma Exacerbation and Chest Pain.

OBJECTIVES: Previous studies have not evaluated the utility of obtaining chest radiographs (CXR) in patients with acute asthma exacerbation reporting chest pain. The aims of this study were to evaluate the symptom of chest pain as a predictor for clinicians obtaining a CXR in these patients and to evaluate chest pain as a predictor of a positive CXR finding. METHODS: This was a retrospective chart review of patients, ages 2 to 18 years, presenting for acute asthma exacerbation to the emergency department from August 1, 2014, to March 31, 2016. Data collected included demographics, clinical data, provider type, and CXR results. Chest radiographs were classified as positive if they showed evidence of pneumonia, pneumothorax, or pneumomediastinum. Multivariate logistic regression models were developed with dependent variables of "obtaining a CXR" and "a positive CXR finding." RESULTS: Seven hundred ninety-three subjects were included in the study. Two hundred thirty-one (29.1%) reported chest pain. Chest radiographs were obtained in 184 patients (23.2%). Of those, 74 patients (40.2%) had chest pain and 21 (11.4%) had a positive CXR. Providers were more likely to obtain CXRs in patients who reported chest pain (odds ratio = 2.2 [95% confidence interval = 1.5-3.2]). Patients reporting chest pain were more likely to have a positive CXR although this difference was not statistically significant (odds ratio = 2.0 [95% confidence interval = 0.7-5.6]). CONCLUSIONS: Providers are more likely to obtain CXRs in asthmatic patients complaining of chest pain; however, these CXRs infrequently yield positive findings. This further supports limiting the use of chest radiography in patients with acute asthma exacerbation.

A reproducible method for determination of nitrocellulose in soil.

A reproducible analytical method for determination of nitrocellulose in soil is described. The new method provides the precision and accuracy needed for quantitation of nitrocellulose in soils to enable worker safety on contaminated sites. The method utilizes water and ethanol washes to remove co-contaminants, acetone extraction of nitrocellulose, and base hydrolysis of the extract to reduce nitrate groups. The hydrolysate is then neutralized and analyzed by ion chromatography for determination of free nitrate and nitrite. A variety of bases for hydrolysis and acids for neutralization were evaluated, with 5N sodium hydroxide and carbon dioxide giving the most complete hydrolysis and interference-free neutralization, respectively. The concentration of nitrocellulose in the soil is calculated from the concentrations of nitrate and nitrite and the weight percentage of nitrogen content in nitrocellulose. The laboratory detection limit for the analysis is 10mg/kg. The method acceptance range for recovery of nitrocellulose from control samples is 78-105%.