Evaluation of the utility of radiography in acute bronchiolitis.
OBJECTIVE
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.


METHODS
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.
Schuh
Suzanne
S
Division 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
Lalani
Amina
A
Allen
Upton
U
Manson
David
D
Babyn
Paul
P
Stephens
Derek
D
MacPhee
Shannon
S
Mokanski
Matthew
M
Khaikin
Svetlana
S
Dick
Paul
P
D000208:Acute Disease; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001988:Bronchiolitis / Q000000981:diagnostic imaging* / Q000188:drug therapy; D015331:Cohort Studies; D004363:Drug Utilization; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies; D011859:Radiography; D012680:Sensitivity and Specificity
D000900:Anti-Bacterial Agents