Clinical predictors of radiographic abnormalities among infants with bronchiolitis in a paediatric emergency department

Ecochard-Dugelay, Emmanuelle; Beliah, Muriel; Perreaux, Francis; Laveaucoupet, J. De; Bouyer, Jean; Epaud, Ralph; Labrune, Philippe; Ducou-le-Pointe, Hubert; Gajdos, Vincent

doi:10.1186/1471-2431-14-143

Cited by 23 publications

(22 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A point of distinction between narrowly and broadly classified bronchiolitis was the increased prescription of antipyretics in those with narrow diagnosis codes. This contrasts with operationalized definitions of bronchiolitis which do not include fever, and with clinical descriptions of bronchiolitis which note the presence of fever in 32 to 55% [3, 12, 13, 16]. This compares with our observed prevalence of antipyretic prescription in 90% of narrowly and 53% in broadly classified bronchiolitis.…”

Section: Discussioncontrasting

confidence: 97%

Which ICD-9-CM codes should be used for bronchiolitis research?

Walsh

Rothenberg

2018

BMC Med Res Methodol

View full text Add to dashboard Cite

BackgroundBronchiolitis is a common respiratory disorder in children. Although there are specific ICD-9-CM diagnosis codes for bronchiolitis, the illness is often coded using broader diagnosis codes. This creates the potential for subject misclassification if researchers rely on specific diagnosis codes when assembling retrospective cohorts. Here we challenge the common research practice of relying on specific diagnosis codes for bronchiolitis.MethodsWe examined the use of diagnosis codes for the first episode of bronchiolitis, bronchitis, acute asthma, and bronchospasm and wheezing, in children younger than six and 24 months in the State of California Medic-Aid database. We categorized codes as narrow or broad diagnosis codes. We compared patient, geographic, and temporal characteristics of the different diagnoses codes.ResultsWe identified visits from 48,732 children for first episode of wheezing illness. We retained 48,269 who had the diagnosis codes and data of interest. Diagnosis codes for acute asthma were widely used, even in children younger than six months in whom a diagnosis code for bronchiolitis would have been anticipated. The temporal pattern was similar across all diagnoses. Antipyretics were prescribed more often in those with diagnosis codes for bronchiolitis and bronchitis. Other statistically significant differences were too small to usefully distinguish the groups. There was substantial geographic variability in the diagnosis codes selected.ConclusionUsers of Medic-Aid administrative data should generally favor broad rather than narrow definitions of bronchiolitis and should perform sensitivity analysis comparing broad and narrow definitions.Electronic supplementary materialThe online version of this article (10.1186/s12874-018-0589-4) contains supplementary material, which is available to authorized users.

show abstract

Section: Discussioncontrasting

confidence: 97%

Which ICD-9-CM codes should be used for bronchiolitis research?

Walsh

Rothenberg

2018

BMC Med Res Methodol

View full text Add to dashboard Cite

show abstract

“…There was also inadequate historical and clinical data. The study by Ecochard-Dugelay et al 26 did not provide data sufficient to make a 2 9 2 table, and an attempt was made to contact the author to obtain original data, without success. The study by Ecochard-Dugelay et al 26 did not provide data sufficient to make a 2 9 2 table, and an attempt was made to contact the author to obtain original data, without success.…”

Section: Description Of Included Studiesmentioning

confidence: 99%

Predictors of Airspace Disease on Chest X‐ray in Emergency Department Patients With Clinical Bronchiolitis: A Systematic Review and Meta‐analysis

Chao

Lin

Marneni

et al. 2016

Academic Emergency Medicine

View full text Add to dashboard Cite

No single predictor of a +CXR was of sufficient accuracy to either support or refute ordering a CXR in a child with clinical bronchiolitis. We provide a decision threshold model to estimate a test threshold for obtaining a CXR and a treatment threshold for administering antibiotics. Application of this model requires the clinician to approximate the empiric benefit of antibiotics based on the clinical situation, highlighting the importance of clinical assessment.

show abstract

“…21 Emmanuelle Dugelay et al stated that presence of crackles were independent clinical predictors of chest radiography prescription in Bronchiolitis (p = 0.003), while these variables did not appear to predict a greater risk of radiographic abnormalities. 22 Lynch T et al showed that crackles/crepts had a significant correlation with the chest radiography findings with the p-value of 0.001. 10 Crackles/crepitations on auscultation (in the absence of wheeze) have been found to be strongly associated with, or highly sensitive for, radiologically diagnosed pneumonia were stated in two other studies.…”

Section: Discussionmentioning

confidence: 99%

How good are the examination findings in predicting the chest radiographic abnormalities amongst children with LRTI?

Goel

Kher

Vagha

2016

Int J Contemp Pediatr

View full text Add to dashboard Cite

INTRODUCTIONAcute lower respiratory tract infections are an important cause of mortality and morbidity in children below five years of age. In the developing countries pneumonia alone kills 3 million children every year. It is responsible for 19% of all deaths in children below five years of age. Of these, 90 to 95% are in the developing countries. 1,2The interpretation of the radiograph depends upon several factors such as quality of the film and competence of the interpreter.3,4 The quality of film largely depends on the machine that is being used, milliamperage, kilo voltage peak, exposure time and, in paediatrics, the cooperation of the patient.The standard management thereafter of acute respiratory infections (ARI) in children less than five years of age has been recommended under Integrated Management of Childhood Illnesses (IMNCI) protocol developed by WHO. Unnecessary intervention results in wasting of financial resources of poor patients both in obtaining the ABSTRACT Background: Acute lower respiratory tract infections are an important cause of mortality and morbidity in children below five years of age. Plain chest radiograph remains the most accessible and commonly used radiological tool. The present study is thus designed to clinically evaluate children with pneumonia, to identify the risk factors and correlate them with the X-ray findings. Methods: Our study was an observational and Analytical study. A total of 250 patients from the age group of 2 months to 5 years, admitted in paediatrics wards with respiratory complaints suggestive of involvement of lower respiratory tract whose X-rays were done were included in our study. All the patients were examined by the clinical experts every day and the findings were being confirmed by at least two experts. Radiologists/residents in the department made the first assessment during their daily practice through online database. The radiologist, who was not informed about the results of the first assessment, re-examined the radiographs. X-ray findings were then compared with clinical features. Results: Out of 250 children, 137 patients had normal radiographs and 113 had abnormal radiographs. Pallor, intercostal retractions, subcostal retractions, grunt, nasal flaring, decreased breath sounds and crepts had a sensitivity of 80. 53%, 84.07%, 76.99%, 70.80%, 76.99%, 73.45%, 62.83% and specificity of 30.66%, 35.77%, 67.88%, 82.48%, 36.50%, 88.32%, 49.64% respectively, in predicting the chest X-ray abnormalities in LRTI. Conclusions: Tachypnea, pallor, retractions, grunt, nasal flaring, decreased breath sounds and crepitations were the main indicators of ALRI confirmed by X-ray. Inspection and Auscultation were two more important pillars of Respiratory system examination in children, where we could predict abnormal X-ray findings.

show abstract

Clinical predictors of radiographic abnormalities among infants with bronchiolitis in a paediatric emergency department

Cited by 23 publications

References 20 publications

Which ICD-9-CM codes should be used for bronchiolitis research?

Which ICD-9-CM codes should be used for bronchiolitis research?

Predictors of Airspace Disease on Chest X‐ray in Emergency Department Patients With Clinical Bronchiolitis: A Systematic Review and Meta‐analysis

How good are the examination findings in predicting the chest radiographic abnormalities amongst children with LRTI?

Contact Info

Product

Resources

About