title: Clinical predictors of radiographic abnormalities among infants with bronchiolitis in a paediatric emergency department.
abstract: BACKGROUND
  Acute viral respiratory exacerbation is one of the most common conditions encountered in a paediatric emergency department (PED) during winter months. We aimed at defining clinical predictors of chest radiography prescription and radiographic abnormalities, among infants with bronchiolitis in a paediatric emergency department.
  
  
  METHODS
  We conducted a prospective cohort study of children less than 2 years of age with clinical bronchiolitis, who presented for evaluation at the paediatric emergency department of an urban general hospital in France. Detailed information regarding historical features, examination findings, and management were collected. Clinical predictors of interest were explored in multivariate logistic regression models.
  
  
  RESULTS
  Among 410 chest radiographs blindly interpreted by two experts, 40 (9.7%) were considered as abnormal. Clinical predictors of chest radiography achievement were age (under three months), feeding difficulties, fever over 38°C, hypoxia under than 95% of oxygen saturation, respiratory distress, crackles, and bronchitis rales. Clinical predictors of radiographic abnormalities were fever and close to significance hypoxia and conjunctivitis.
  
  
  CONCLUSIONS
  Our study provides arguments for reducing chest radiographs in infants with bronchiolitis. For infants with clinical factors such as age less than three months, feeding difficulties, respiratory distress without hypoxia, isolated crackles or bronchitis rales, careful clinical follow-up should be provided instead of chest radiography.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Ecochard-Dugelay
authors.forename: Muriel
authors.initials: M
authors.lastname: Beliah
authors.forename: Francis
authors.initials: F
authors.lastname: Perreaux
authors.forename: Jocelyne
authors.initials: J
authors.lastname: de Laveaucoupet
authors.forename: Jean
authors.initials: J
authors.lastname: Bouyer
authors.forename: Ralph
authors.initials: R
authors.lastname: Epaud
authors.forename: Philippe
authors.initials: P
authors.lastname: Labrune
authors.forename: Hubert
authors.initials: H
authors.lastname: Ducou-Lepointe
authors.affiliation: INSERM U1018, Paris 94270, Le Kremlin Bicêtre France. vincent.gajdos@abc.aphp.fr.
authors.forename: Vincent
authors.initials: V
authors.lastname: Gajdos
mesh_terms: D001988:Bronchiolitis / Q000000981:diagnostic imaging* / Q000453:epidemiology; D001991:Bronchitis / Q000453:epidemiology; D003231:Conjunctivitis / Q000453:epidemiology; D004636:Emergency Service, Hospital; D005247:Feeding Behavior; D005260:Female; D005334:Fever / Q000453:epidemiology; D006801:Humans; D000860:Hypoxia / Q000453:epidemiology; D007223:Infant; D008297:Male; D015999:Multivariate Analysis; D010031:Otitis / Q000453:epidemiology; D011446:Prospective Studies; D011859:Radiography; D012131:Respiratory Insufficiency / Q000453:epidemiology; D012135:Respiratory Sounds