Clinical Factors Associated With Chest Imaging Findings in Hospitalized Infants With Bronchiolitis

Abstract

Despite recommendations against routine imaging, chest radiography (CXR) is frequently performed on infants hospitalized for bronchiolitis. We conducted a review of 811 infants hospitalized for bronchiolitis to identify clinical factors associated with imaging findings. CXR was performed on 553 (68%) infants either on presentation or during hospitalization; 466 readings (84%) were normal or consistent with viral illness. Clinical factors significantly associated with normal/viral imaging were normal temperature (odds ratio = 1.66; 95% CI = 1.03-2.67) and normal oxygen saturation (odds ratio = 1.77; 95% CI = 1.1-2.83) on presentation. Afebrile patients with normal oxygen saturations were nearly 3 times as likely to have a normal/viral CXR as patients with both fever and hypoxia. Our findings support the limited role of radiography in the evaluation of hospitalized infants with bronchiolitis, especially patients without fever or hypoxia.

A Self-criticism of Diagnostic and Therapeutic Decision Making in Children Admitted With Acute Lower Respiratory Infection at a Single Pediatric Emergency Department

“…No meaningful associations could be drawn between clinical and laboratory findings and radiologic findings. This is in line with the observation that many physicians continue to perform chest x-ray despite the current bronchiolitis guidelines, which recommend not to obtain routine chest x-rays 14 . In our study, only hospitalized patients were enrolled, so it was not possible to determine the frequency of obtaining chest x-ray in patients with LRI symptoms.…”

“…This is in line with the observation that many physicians continue to perform chest x-ray despite the current bronchiolitis guidelines, which recommend not to obtain routine chest x-rays. 14 In our study, only hospitalized patients were enrolled, so it was not possible to determine the frequency of obtaining chest x-ray in patients with LRI symptoms. It is understandable to a certain extent that all of our patients had a chest x-ray, as the study included only those admitted to the hospital.…”

Respiratory Syncytial Virus: A Systematic Review and Meta-Analysis of Tomographic Findings (2000–2022)

“…Substantial differences were reported across the various age groups, and our study suggests that RSV infections may develop quite different imaging features in healthy children, healthy adults, and immunodeficient individuals [42,56]. In fact, signs of nodular lesions, GGOs, and tree-in-bud opacities, as well as signs of septal thickening, were more frequently reported in healthy adults than in children/adolescents [27,[39][40][41][60][61][62], while individuals affected by immunodeficiency were also characterized by signs of organizing pneumonia and pleural effusions, otherwise rare in children and healthy adults [41,42,51,63]. These age-specific features of RSV infections should be carefully taken in account for achieving an appropriate and timely differential diagnosis with other respiratory pathogens [27].…”

“…As RSV is a very common infection, particularly among infants aged 2 years or less [24,26,[70][71][72][73], the large majority of incident cases were reasonably managed as outpatient cases, not requiring any imaging and, therefore, not being included in the present estimates. Moreover, even among hospitalized (i.e., more severe) cases, CT scans were performed only in highly selected (and not necessar-ily representative cases) cases, in order to better characterize severe respiratory impairment and/or rule out other respiratory infections that would require a specific follow-up, potentially including antimicrobic therapy, otherwise useless in RSV cases [39,40,49,59,74]. In fact, 17.0% of the 1224 CT scan studies included in the pooled sampled population were taken in RSV cases, which in turn represented only a small fraction of all individuals followed by parent healthcare providers.…”

“…As the majority of respiratory pathogens, including SARS-CoV-2, are characterized by substantial clinical overlap but potentially distinctive imaging manifestations, it is reasonable that techniques such as chest CT may retain their importance as a reliable tool for assisting clinical professionals in the post-pandemic practice [27,36]. Nevertheless, as current guidelines recommend that infants with a suspected diagnosis of bronchiolitis should be evaluated by means of noninvasive options (such as point-of-care ultrasonography), reserving imaging studies only for most severe cases [37,38], relatively limited evidence has been collected on the chest CT findings of RSV [36,[39][40][41][42]. Therefore, the aim of this study was to systematically collect and review the chest CT findings of RSV in children compared to other potential groups (i.e., adults, and immunocompromised individuals).…”