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Published on: March 12, 2020
Evaluation of the utility of radiography in acute bronchiolitis
Suzanne Schuh1, Amina Lalani, Upton Allen
1Division of Paediatric Emergency Medicine, Department of Pediatrics, Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. suzanne.schuh@sickkids.on.ca
Insights
Radiographs are rarely inconsistent with typical infant bronchiolitis, suggesting routine imaging is unnecessary. This finding supports avoiding chest X-rays for most infants diagnosed with bronchiolitis.
Area of Science:
- Pediatric Emergency Medicine
- Pediatric Pulmonology
- Diagnostic Imaging
Background:
- Bronchiolitis is a common viral respiratory infection in infants.
- Radiographic findings in bronchiolitis can range from simple airway disease to more complex airspace disease.
- The utility of routine chest radiography in diagnosing typical bronchiolitis remains a subject of debate.
Purpose of the Study:
- To determine the proportion of radiographs inconsistent with typical bronchiolitis in infants.
- To compare the rates of antibiotic therapy intended before versus after radiography.
- To assess the value of routine chest imaging in pediatric bronchiolitis cases.
Main Methods:
- Prospective cohort study involving 265 infants (2-23 months) with bronchiolitis.
- Radiographs were categorized as simple bronchiolitis, complex bronchiolitis, or inconsistent diagnoses.
- Antibiotic therapy rates before and after radiography were recorded.
Main Results:
- Only 0.75% of radiographs were inconsistent with bronchiolitis.
- Simple bronchiolitis was present in 92.8% of cases; complex findings in 6.9%.
- Antibiotics were given post-radiography in 14.7% of infants, versus 2.6% pre-radiography.
Conclusions:
- Routine chest radiography is not indicated for infants with typical bronchiolitis presentations.
- The risk of significant airspace disease is low, particularly in infants with oxygen saturation >92% and mild distress.
- Imaging findings are overwhelmingly consistent with bronchiolitis, supporting a strategy of selective or no imaging.
Objectives:
To determine the proportion of radiographs inconsistent with bronchiolitis in children with typical presentation of bronchiolitis and to compare rates of intended antibiotic therapy before radiography versus those given antibiotics after radiography.
Study Design:
We conducted a prospective cohort study in a pediatric emergency department of 265 infants aged 2 to 23 months with radiographs showing either airway disease only (simple bronchiolitis), airway and airspace disease (complex bronchiolitis), and inconsistent diagnoses (eg, lobar consolidation).
Results:
The rate of inconsistent radiographs was 2 of 265 cases (0.75%; 95% CI 0-1.8). A total of 246 children (92.8%) had simple radiographs, and 17 radiographs (6.9%) were complex. To identify 1 inconsistent and 1 complex radiograph requires imaging 133 and 15 children, respectively. Of 148 infants with oxygen saturation >92% and a respiratory disease assessment score <10 of 17 points, 143 (96.6%) had a simple radiograph, compared with 102 of 117 infants (87.2%) with higher scores or lower saturation (odds ratio, 3.9; 95% CI, 1.3-14.3). Seven infants (2.6%) were identified for antibiotics pre-radiography; 39 infants (14.7%) received antibiotics post-radiography (95% CI, 8-16).
Conclusions:
Infants with typical bronchiolitis do not need imaging because it is almost always consistent with bronchiolitis. Risk of airspace disease appears particularly low in children with saturation higher than 92% and mild to moderate distress.
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