title: [Chest X-ray and acute bronchiolitis: Are these indications decreasing?]
abstract: OBJECTIVE
  A management protocol for infants hospitalized for acute bronchiolitis, established after the study conducted in our unit in 2012, recommends a chest X-ray when the clinical course is unusual or if a differential diagnosis is suspected. The goal of this study was to evaluate professional practices after the introduction of this new management protocol.
  
  
  METHODS
  Retrospective descriptive study in two pediatric units from October 2013 to March 2015, including infants (0-23 months) hospitalized for their first episode of acute bronchiolitis without any underlying chronic condition.
  
  
  RESULTS
  Overall, 599 infants were included (median age, 3.7 months, 54 % boys). Nearly six out of ten (n=355, 59.3 %) had at least one chest radiograph (38.5 % fewer than in 2012). It was abnormal in 96.3 % of cases, revealing distension and/or bronchial wall thickening (56.7 %), focal opacity (23.5 %), or atelectasis (19.5 %). An X-ray was performed out of the recommendations in 42.5 % of cases. The chest X-ray result led to management changes in 52 infants with prescription of antibiotics for pneumonia (86.5 %) and allowed the diagnosis of heart disease in one case (0.2 %). Management of acute bronchiolitis (X-ray and antibiotics) was statistically different between the two pediatric units.
  
  
  CONCLUSIONS
  This protocol led to a significant decrease in the number of chest X-rays. However, many are still performed out of the recommendations, resulting in an increase of antibiotic use for pneumonia.
  
  
  CONCLUSIONS
  The decrease in use of chest X-rays in acute bronchiolitis for hospitalized infants was significant but remains insufficient.
authors.affiliation: Unité de pneumologie pédiatrique et de médecine infantile, CHU Timone-Enfants, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France. Electronic address: valerie.arnoux@ap-hm.fr.
authors.forename: V
authors.initials: V
authors.lastname: Arnoux
authors.affiliation: Unité de pneumologie pédiatrique et de médecine infantile, CHU Timone-Enfants, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France.
authors.forename: A
authors.initials: A
authors.lastname: Carsin
authors.affiliation: Unité de pneumologie pédiatrique et de médecine infantile, CHU Timone-Enfants, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France.
authors.forename: E
authors.initials: E
authors.lastname: Bosdure
authors.affiliation: Service de médecine infantile, hôpital Nord, chemin des Bourrelys, 13915 Marseille cedex 20, France.
authors.forename: K
authors.initials: K
authors.lastname: Retornaz
authors.affiliation: Unité de pneumologie pédiatrique et de médecine infantile, CHU Timone-Enfants, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France.
authors.forename: B
authors.initials: B
authors.lastname: Chabrol
authors.affiliation: Service de radiologie pédiatrique, CHU Timone-Enfants, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France.
authors.forename: G
authors.initials: G
authors.lastname: Gorincour
authors.affiliation: Service de santé publique et d'information médicale, hôpital de la Timone, AP-HM, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France; SESSTIM (UMR 912, Inserm, IRD), faculté de médecine, Aix-Marseille université, 13282 Marseille, France.
authors.forename: J
authors.initials: J
authors.lastname: Mancini
authors.affiliation: Service de radiologie pédiatrique, CHU Timone-Enfants, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France.
authors.forename: A
authors.initials: A
authors.lastname: Dabadie
authors.affiliation: Unité de pneumologie pédiatrique et de médecine infantile, CHU Timone-Enfants, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France; Service de médecine infantile, hôpital Nord, chemin des Bourrelys, 13915 Marseille cedex 20, France; CNRS, URMITE 6236, faculté de médecine, Aix-Marseille université, 13385 Marseille cedex 5, France.
authors.forename: J-C
authors.initials: JC
authors.lastname: Dubus
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001988:Bronchiolitis / Q000000981:diagnostic imaging*; D002985:Clinical Protocols; D005260:Female; D005602:France; D006801:Humans; D007223:Infant; D008297:Male; D011014:Pneumonia / Q000000981:diagnostic imaging / Q000188:drug therapy; D001261:Pulmonary Atelectasis / Q000000981:diagnostic imaging; D013902:Radiography, Thoracic / Q000706:statistics & numerical data*; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents