Evaluation of the Utility of Radiography in Acute Bronchiolitis

Schuh, Suzanne; Lalani, Amina; Allen, Upton; Manson, David; Babyn, Paul; Stephens, Derek; MacPhee, Shannon; Mokanski, Matthew; Khaikin, Svetlana; Dick, Paul T.

doi:10.1016/j.jpeds.2007.01.005

Cited by 144 publications

(131 citation statements)

References 34 publications

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“…Chest x-rays have been determined to add little to management and increase the use of antibiotics. 9,21 Viral studies also have no clinical benefit. 21,24 The inter-hospital variation we found may reflect differing hospital isolation policies.…”

Section: Discussionmentioning

confidence: 99%

“…Admission rates have between reported at 13% among a cohort of patients treated at either a pediatric or a general hospital, 39 at 31% among a cohort treated at pediatric emergency departments, 9 and at 37% among a cohort treated at a general hospital. 26 The variation may reflect differences in illness severity as well as differences in physician comfort in managing bronchiolitis.…”

Section: Discussionmentioning

confidence: 99%

“…[6][7][8] The utilization of unproven therapies and investigations for bronchiolitis management increases health care costs. 9 Several pediatric centres have demonstrated a reduction in the use of beta-agonist therapy, chest x-rays, and viral testing with implementation of a bronchiolitis clinical practice guideline (CPG). [10][11][12][13] However, most children with bronchiolitis who present to a hospital are treated and discharged from the emergency department (ED).…”

Section: Introductionmentioning

confidence: 99%

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Management of Bronchiolitis in Community Hospitals in Ontario: a Multicentre Cohort Study

Plint

Taljaard

McGahern³

et al. 2016

CJEM

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Objectives: Bronchiolitis is the leading cause of hospital admission for infants, but few studies have examined management of this condition in community hospital settings. We reviewed the management of children with bronchiolitis presenting to community hospitals in Ontario. Methods: We retrospectively reviewed a consecutive cohort of infants less than 12 months old with bronchiolitis who presented to 28 Ontario community hospitals over a two-year period. Bronchiolitis was defined as first episode of wheezing associated with signs of an upper respiratory tract infection during respiratory syncytial virus season. Results: Of 543 eligible children, 161 (29.7%, 95% Confidence Interval (CI) 22.3 to 37.0%) were admitted to hospital. Hospital admission rates varied widely (Interquartile Range 0%-40.3%). Bronchodilator use was widespread in the emergency department (ED) (79.7% of patients, 95% CI 75.0 to 84.5%) and on the inpatient wards (94.4% of patients, 95% CI 90.2 to 98.6%). Salbutamol was the most commonly used bronchodilator. At ED discharge 44.7% (95% CI 37.5 to 51.9%) of patients were prescribed a bronchodilator medication. Approximately one-third of ED patients (30.8%, 95% CI 22.7 to 38.8%), 50.3% (95% CI 37.7 to 63.0%) of inpatients, and 23.5% (95% CI 14.4 to 32.7) of patients discharged from the ED were treated with corticosteroids. The most common investigation obtained was a chest x-ray (60.2% of all children; 95% CI 51.9 to 68.5%). Conclusions: Infants with bronchiolitis receive medications and investigations for which there is little evidence of benefit. This suggests a need for knowledge translation strategies directed to community hospitals. RÉSUMÉObjectif: La bronchiolite est le principal motif d'hospitalisation des enfants en bas âge, mais peu d'études ont porté sur la prise en charge de la maladie, dans les hôpitaux communautaires. Les auteurs de l'étude ont donc examiné la prise en charge de la maladie chez les enfants traités dans les hôpitaux communautaires, en Ontario. Méthode: Les auteurs ont procédé à un examen rétrospectif d'une cohorte d'enfants consécutifs, âgés de moins de 12 mois, qui souffraient d'une bronchiolite et qui ont été traités dans 28 hôpitaux communautaires en Ontario, sur une période de 2 ans. La bronchiolite a été définie comme un premier épisode de respiration sifflante, associé à des signes d'une infection des voies respiratoires supérieures durant la période du virus respiratoire syncytial. Résultats: Sur 543 enfants admissibles à l'étude, 161 (29,7%; intervalle de confiance [IC] à 95% : 22,3 à 37,0%) ont été hospitalisés. Les taux d'admission à l'hôpital variaient énormément (intervalle interquartile : 0-40,3%). L'utilisation des bronchodilatateurs était courante au service des urgences (SU) (79,7% des patients; IC à 95% : 75,0 à 84,5%) ainsi qu'à l'étage (94,4% des patients; IC à 95% : 90,2 à 98,6%). Le salbutamol était le brochodilatateur le plus utilisé. Au moment du congé du SU, un brochodilatateur avait été prescrit à 44,7% (IC à 95% : 37,5 à 51,9%) des pa...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Management of Bronchiolitis in Community Hospitals in Ontario: a Multicentre Cohort Study

Plint

Taljaard

McGahern³

et al. 2016

CJEM

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“…37% of those patients have a normal chest X-ray [116]. The chest X-ray does not influence clinical care for 92.8% of those patients [117]. If one can identify the patients who will have an unhelpful chest X-ray beforehand, their exposure to radiation and costs associated with unnecessary chest X-rays can be minimized.…”

Section: Predicting An Unhelpful Chest X-raymentioning

confidence: 99%

“…If one can identify the patients who will have an unhelpful chest X-ray beforehand, their exposure to radiation and costs associated with unnecessary chest X-rays can be minimized. Since patients having a chest X-ray are more likely to receive inappropriate additional therapies such as antibiotics, saving an unhelpful chest X-ray can also save these unnecessary therapies, if any, and their associated costs [28,117].…”

Section: Predicting An Unhelpful Chest X-raymentioning

confidence: 99%

A systematic review of predictive modeling for bronchiolitis

Luo

Nkoy

Gesteland

et al. 2014

International Journal of Medical Informatics

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Purpose: Bronchiolitis is the most common cause of illness leading to hospitalization in young children. At present, many bronchiolitis management decisions are made subjectively, leading to significant practice variation among hospitals and physicians caring for children with bronchiolitis. To standardize care for bronchiolitis, researchers have proposed various models to predict the disease course to help determine a proper management plan. This paper reviews the existing state of the art of predictive modeling for bronchiolitis. Predictive modeling for respiratory syncytial virus (RSV) infection is covered whenever appropriate, as RSV accounts for about 70% of bronchiolitis cases.Methods: A systematic review was conducted through a PubMed search up to April 25, 2014. The literature on predictive modeling for bronchiolitis was retrieved using a comprehensive search query, which was developed through an iterative process.Search results were limited to human subjects, the English language, and children (birth-18 years). Results:The literature search returned 2,312 references in total. After manual review, 168 of these references were determined to be relevant and are discussed in this paper. We identify several limitations and open problems in predictive modeling for bronchiolitis, and provide some preliminary thoughts on how to address them, with the hope to stimulate future research in this domain. Conclusions:Many problems remain open in predictive modeling for bronchiolitis. Future studies will need to address them to achieve optimal predictive models.

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Pneumonia in Children Presenting to the Emergency Department With an Asthma Exacerbation

et al. 2016

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Evaluation of the Utility of Radiography in Acute Bronchiolitis

Abstract: 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.

Cited by 144 publications

References 34 publications

Management of Bronchiolitis in Community Hospitals in Ontario: a Multicentre Cohort Study

Management of Bronchiolitis in Community Hospitals in Ontario: a Multicentre Cohort Study

A systematic review of predictive modeling for bronchiolitis

Pneumonia in Children Presenting to the Emergency Department With an Asthma Exacerbation

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