Evaluation of the Utility of Radiography in Acute Bronchiolitis
Presented in part at the Pediatric Academic Societies Meeting, May 2006, San Francisco, CA.
Received 5 June 2006; received in revised form 5 October 2006; accepted 2 January 2007.
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.
aDivision of Paediatric Emergency Medicine, Department of Pediatrics, Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
bDivision of Infectious Diseases, Department of Pediatrics, Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
cDivision of Paediatric Medicine, Department of Pediatrics, Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
dDepartment of Diagnostic Imaging, Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
eDepartment of Population Health Sciences, Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Reprint requests: Dr Suzanne Schuh, Division of Paediatric Emergency Medicine, The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8.
Supported by a peer reviewed grant from the Physicians’ Services Incorporated Foundation of Ontario. This funding agency played no role in the design and conduct of the study, collection, management, analysis, and interpretation of the data, or preparation, review, or approval of the manuscript.
ABSTRACT