[Chest radiograph in bronchiolitis: is it always necessary?]

Area of Science:

• Pediatric Emergency Medicine
• Pediatric Pulmonology
• Diagnostic Imaging

Background:

• Routine chest radiography in infants with bronchiolitis increases healthcare costs.
• Unnecessary radiation exposure is a concern for pediatric patients.

Purpose of the Study:

• Evaluate the prevalence of infiltrate/atelectasis in infants with bronchiolitis.
• Assess the impact of chest radiograph results on patient management.
• Identify clinical predictors for normal chest radiographs to reduce unnecessary imaging.

Main Methods:

• Prospective study of 252 infants (<24 months) diagnosed with bronchiolitis.
• Data collected: age, sex, onset, respiratory rate, temperature, oxygen saturation, auscultation findings, and identified virus.
• Chest radiograph findings and changes in management before and after results were analyzed.

Main Results:

• Infiltrate/atelectasis found in 14.3% of infants.
• Fever (≥38°C) and hypoxia (<94% O2 saturation) were associated with infiltrate/atelectasis.
• Patient management changed in 30% of cases with infiltrate/atelectasis.
• Normal chest radiographs predicted in 92% of infants with normal temperature and oxygen saturation.

Conclusions:

• Most infants with bronchiolitis have normal chest radiographs.
• Fever and hypoxia are significant predictors of infiltrate/atelectasis.
• Absence of fever and hypoxia can reliably predict normal chest radiographs, supporting reduced imaging.