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Updated: Aug 8, 2026
Protocol and Guidelines for Point-of-Care Lung Ultrasound in Diagnosing Neonatal Pulmonary Diseases Based on International Expert Consensus
Published on: March 6, 2019
[Chest radiograph in bronchiolitis: is it always necessary?]
María L García García1, C Calvo Rey, S Quevedo Teruel
1Servicios de Pediatría, Hospital Severo Ochoa, Leganés, Madrid, Spain. marialuzgarcia@terra.es
Insights
Routine chest X-rays for infants with bronchiolitis are often unnecessary. Fever and low oxygen saturation are key indicators for potential infiltrate/atelectasis, guiding the need for radiological investigation in pediatric patients.
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.
Background:
The routine use of chest radiograph in infants with bronchiolitis increases health costs and can often unnecessarily expose the patient to radiation.
Objectives:
To evaluate the prevalence of infiltrate/atelectasis in infants younger than 2 years who presented to the emergency department with bronchiolitis, to assess whether patient management is changed after viewing the chest radiograph and to determine which clinical variables can accurately identify children with normal radiographs, with a view to reducing unnecessary radiological investigations.
Patients And Methods:
From October 2003 to December 2004, infants aged < 24 months evaluated in the emergency department of the Severo Ochoa Hospital (Madrid) with a diagnosis of bronchiolitis were included in this study. The variables registered were age, sex, time since onset, respiratory rate, temperature, asymmetry on auscultation, oxygen saturation and the virus identified. A chest radiograph was obtained and the need for admission was evaluated before and after obtaining the results.
Results:
Two hundred fifty-two infants were included, of which 50 % were aged less than 5 months. Infiltrate/atelectasis was identified in 14.3 % (95 % CI: 10.1-18.5; kappa coefficient: 0.64). Patients with infiltrate/atelectasis were 2.5 times more likely to have a temperature of > or = 38 degrees C (p: 0.004), O2 saturation of < 94 % (p: 0,006) and to be admitted before the results of chest radiograph were known. No differences were found between children with and without infiltrate in age at presentation, sex, disease duration, respiratory rate or identified virus. Patient management was modified in 30 % of patients with infiltrate/ atelectasis. Patients with a temperature of < 38 degrees and O2 saturation of > 94 % had a 92 % probability of normal chest radiograph.
Conclusions:
Most infants presenting with bronchiolitis had a normal chest radiograph. Temperature >or = 38 degrees and O2 saturation < 94 % were significantly associated with infiltrate/atelectasis. In most infants with bronchiolitis, the absence of fever and hypoxia are good predictors of normal chest radiographs.
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