Radiografía de tórax en la bronquiolitis: ¿es siempre necesaria?

García, M.aL. García; Calvo, Cristina; Teruel, Sergio Quevedo; Pérez, M.; Ortega, Francisca Sánchez; Valle, Francesco; Sánchez, F.; Pérez-Breña, Pilar

doi:10.1016/s1695-4033(04)78800-1

Cited by 12 publications

(5 citation statements)

References 22 publications

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“…Thus, our results encourage to restrict CR prescription to infants with fever. Those clinical predictors of radiographic abnormalities are consistent with previous studies [3,4,12,13,16-18]. Neuman et al conducted a large prospective cohort study to assess the relation between historical features and physical examination findings and radiographic pneumonia [4].…”

Section: Discussionsupporting

confidence: 85%

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

et al. 2014

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BackgroundAcute 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.MethodsWe 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.ResultsAmong 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.ConclusionOur 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.

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Section: Discussionsupporting

confidence: 85%

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

et al. 2014

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“…A previous study determined that young children with oxygen saturation ≤92% or a Respiratory Disease Assessment Instrument (RDAI) clinical score ≥10 of 17 points were more likely to have pathologic chest radiographic findings than their counterparts 10) . Another study found that body temperature ≥38℃ and oxygen saturation <94% were associated with infiltrates/atelectasis 9) . Finally, a recent study reported that the presence of fever was the only significant clinical predictor of radiographic abnormalities among their cohort 7) .…”

Section: Discussionmentioning

confidence: 99%

“…Subjects with bronchiolitis may also have pneumonia detected by chest X-ray 7 8 9 10) . A previous study analyzing patients less than 24 months of age admitted via the emergency department with the diagnosis of bronchiolitis found that 15 subjects out of 122 patients (12.3%) showed abnormal chest X-ray findings such as atelectasis or consolidation 8) .…”

Section: Discussionmentioning

confidence: 99%

“…For example, a survey of clinical practices in the diagnosis and management of 17,397 children with bronchiolitis reported that 72% of them received chest radiographs 6) . Accordingly, there are several studies demonstrating that the majority of these chest radiographies done on children with bronchiolitis were read as negative and thus of little clinical use 6 7 8 9 10) . However, there are no studies determining the proportion of children with pathologic chest radiographic findings in Korean children admitted with bronchiolitis.…”

Section: Introductionmentioning

confidence: 99%

“…However, there are no studies determining the proportion of children with pathologic chest radiographic findings in Korean children admitted with bronchiolitis. Furthermore, there are only 3 studies in the literature reporting risk factors for radiographic abnormalities among young children with bronchiolitis 7 9 10) . Determining the proportion of children with pathologic chest radiographic findings and understanding these risk factors could help clinicians reduce the number of chest X-rays and thus avoid unnecessary radiation exposure for children.…”

Section: Introductionmentioning

confidence: 99%

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Clinical predictors of chest radiographic abnormalities in young children hospitalized with bronchiolitis: a single center study

Kim

Baek

et al. 2016

Korean J Pediatr

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PurposeChest radiography is often performed on patients hospitalized with typical clinical manifestations of bronchiolitis. We aimed to determine the proportion of subjects with pathologic chest radiographic findings and the clinical predictors associated with pathologic chest radiographic findings in young children admitted with the typical presentation of bronchiolitis.MethodsWe obtained the following data at admission: sex, age, neonatal history, past history of hospitalization for respiratory illnesses, heart rate, respiratory rate, the presence of fever, total duration of fever, oxygen saturation, laboratory parameters (i.e., complete blood cell count, high-sensitivity C-reactive protein [hs-CRP], etc.), and chest radiography.ResultsThe study comprised 279 young children. Of these, 26 had a chest radiograph revealing opacity (n=24) or atelectasis (n=2). Multivariate logistic regression analysis showed that after adjustment for confounding factors, the clinical predictors associated with pathologic chest radiographic findings in young children admitted with bronchiolitis were elevated hs-CRP level (>0.3 mg/dL) and past history of hospitalization for respiratory illnesses (all P<0.05).ConclusionThe current study suggests that chest radiographs in young children with typical clinical manifestations of bronchiolitis have limited value. Nonetheless, young children with clinical factors such as high hs-CRP levels at admission or past history of hospitalization for respiratory illnesses may be more likely to have pathologic chest radiographic findings.

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Nebulized Magnesium Sulphate in Bronchiolitis: A Randomized Controlled Trial

et al. 2021

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Objective To evaluate the efficacy and safety of nebulized magnesium sulphate as a bronchodilator in young children aged 1-24 mo with moderate to severe bronchiolitis in comparison to standard therapy. Methods This was an open labeled randomized controlled trial comprising 60 children with moderate to severe bronchiolitis which was randomly assigned to 2 groups. Intervention group received nebulization with 3 mL of 3.2% magnesium sulphate (MgSO 4 ) (iso-osmolar) every 4 hourly for 24 h in addition to standard care and the control group received standard care alone. The primary outcome measure was to compare the improvement of bronchiolitis severity score (BSS) and length of hospitalization. The secondary outcome was to measure the need for noninvasive ventilation, need for admission to intensive care unit (ICU) in the initial visit, to evaluate the safety of magnesium sulphate and need for clinic revisit, hospital readmission and ICU readmission within 2 wk after discharge in both the groups. Results The mean age of children allocated in the control group was 7.4 ± 5.1 mo and 7.7 ± 4.5 mo in the intervention group. There was no significant difference with respect to improvement of BSS or reduced length of hospitalization in both the groups (p > 0.05). BSS monitored sequentially after enrollment at 1, 2, 4, 8, 12, 16, and 24 h did not show statistically significant differences between the groups. Mean length of hospital stay was 2.89 ± 2.25 d in treatment group and 2.96 ± 1.86 d in control group (p = 0.902). No adverse events were observed in both the groups. Conclusion Nebulized magnesium sulphate is not superior to standard therapy in children with moderate to severe bronchiolitis.

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Radiografía de tórax en la bronquiolitis: ¿es siempre necesaria?

Cited by 12 publications

References 22 publications

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

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

Clinical predictors of chest radiographic abnormalities in young children hospitalized with bronchiolitis: a single center study

Nebulized Magnesium Sulphate in Bronchiolitis: A Randomized Controlled Trial

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