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Routine Chest X-Rays in Critical Bronchiolitis Do Not Improve Outcomes.

Trisha Sunderajan1, Da-Eun Shira Choi2, Caroline LaFerla2

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|November 13, 2025
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Summary

Routine chest X-rays (CXRs) in critical bronchiolitis may prolong intensive care unit length of stay (ICU-LOS) and level of respiratory support (ICU-LRS). This study found CXRs were associated with longer ICU stays despite similar illness severity.

Keywords:
CXRcritical bronchiolitiscritical bronchiolitis scorenon-invasive ventilation

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Area of Science:

  • Pediatrics
  • Critical Care Medicine
  • Pulmonology

Background:

  • Chest X-rays (CXRs) are frequently used in diagnosing bronchiolitis, despite American Academy of Pediatrics recommendations against routine use.
  • The clinical utility and impact of CXRs in critically ill infants with bronchiolitis remain under investigation.

Purpose of the Study:

  • To evaluate the association between obtaining chest X-rays (CXRs) and outcomes in critically ill pediatric patients with bronchiolitis.
  • To assess the impact of CXRs on intensive care unit length of stay (ICU-LOS) and intensive care unit level of respiratory support (ICU-LRS).

Main Methods:

  • A retrospective cohort study involving 107 children under three years old admitted to intensive care units.
  • Patients were analyzed in two groups: those who received a CXR and those who did not.
  • Intensive care unit length of stay (ICU-LOS) and intensive care unit level of respiratory support (ICU-LRS) were primary outcomes, compared against predicted values using the critical bronchiolitis score (CBS).

Main Results:

  • 61% of patients received a CXR.
  • Patients who underwent CXR had significantly longer ICU-LOS (p=0.01) and required higher ICU-LRS (p=0.02) compared to those without CXR.
  • While illness severity was similar between groups, the difference between actual and predicted ICU-LOS was greater in the no-CXR group.

Conclusions:

  • Routine CXRs are common in critically ill bronchiolitis patients.
  • The use of CXRs may be associated with prolonged ICU-LOS and increased ICU-LRS, independent of actual illness severity.
  • Further research is needed to clarify the role of CXRs in managing critical bronchiolitis.