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Published on: December 10, 2013
Investigations for Bronchiolitis in Infants: An Overview of Reviews and Systematic Review of Primary Studies
Kate Loveys1, Meredith L Borland2,3,4, Ed Oakley5,6,7
1Department of Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand.
Insights
Chest X-ray (CXR), laboratory, and viral tests show limited clinical utility for typical infant bronchiolitis management. Routine use is not recommended due to insufficient evidence, especially in severe cases or unexpected deterioration.
Area of Science:
- Pediatrics
- Infectious Diseases
- Diagnostic Accuracy
Background:
- Bronchiolitis is a common viral respiratory infection in infants.
- Clinical management often involves diagnostic testing, including chest X-ray (CXR), laboratory tests, and viral panels.
- The utility of these investigations, particularly in severe cases, remains debated.
Purpose of the Study:
- To synthesize evidence on the clinical utility of CXR, laboratory, and viral testing in infants with bronchiolitis.
- To evaluate these tests in subgroups with severe disease (e.g., ICU admission) or unexpected deterioration.
- To inform evidence-based guidelines for diagnostic testing in bronchiolitis.
Main Methods:
- Conducted an overview of reviews and a systematic review of primary studies.
- Searched multiple databases (MEDLINE, EMBASE, PubMed, Cochrane, CINAHL) from 2000 to February 2025.
- Assessed risk of bias (ROBIS, NOS) and certainty of evidence (GRADE); results were synthesized narratively.
Main Results:
- Included 30 publications (23,605 infants).
- For typical bronchiolitis, CXR, lab tests, and viral tests showed insufficient diagnostic accuracy and limited association with clinical outcomes (very low certainty evidence).
- In severe disease, certain inflammatory markers (procalcitonin, CRP) showed some benefit in predicting bacterial co-infection; evidence was lacking for unexpected deterioration.
Conclusions:
- Current evidence suggests limited clinical utility of routine CXR, laboratory, and viral testing in typical infant bronchiolitis.
- These tests should not be routinely used in uncomplicated cases.
- Further research is needed for subgroups with severe disease or unexpected deterioration.
Aim:
To synthesize evidence on the clinical utility of chest X-ray (CXR), laboratory and viral testing in infants with bronchiolitis, including in subgroups with unexpected deterioration or intensive care unit (ICU) admission (severe disease).
Methods:
An overview of reviews and systematic review of primary studies were conducted. MEDLINE, EMBASE, PubMed, Cochrane Library, CINAHL were searched (2000 to 19/02/25) for systematic reviews and primary studies evaluating investigations in bronchiolitis management at hospital. Risk of bias (ROBIS, NOS) and certainty of evidence (GRADE) were evaluated. Results were narratively synthesized.
Results:
Thirty/28,602 publications were included (N = 23,605 infants, N = 59 studies; three systematic reviews [32 studies], 27 observational studies). In typical bronchiolitis: (1) CXR demonstrated insufficient diagnostic accuracy, increased antibiotic prescriptions, and was not associated with ICU length of stay (LOS) (very low quality of evidence); (2) Laboratory test results were not associated with mortality, and were inconsistent for LOS (very low quality of evidence); (3) Viral testing results were not associated with ICU admission, and were inconsistent for hospitalization (very low quality of evidence). In infants with severe disease: serum procalcitonin and c-reactive protein testing at ICU admission had some benefit in predicting bacterial co-infection and/or pneumonia (very low quality evidence). Evidence was lacking for infants with unexpected deterioration.
Conclusions:
Very low certainty evidence indicates that CXR, laboratory and viral testing may have limited clinical utility in individual management of typical bronchiolitis, and should not be routinely used in this group. Further research is required in subgroups with unexpected deterioration or severe disease.
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