2011, Number 3
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Bol Med Hosp Infant Mex 2011; 68 (3)
Chest X-ray: an unnecessary resource in the diagnosis of acute bronchiolitis
Castillo GR, Cuello GCA
Language: Spanish
References: 21
Page: 213-219
PDF size: 334.76 Kb.
ABSTRACT
Background. Bronchiolitis is one of the leading controversial pediatric diseases because of its variations in diagnosis and treatment. Use
of diagnostic resources beyond the clinical features is usually unnecessary in its classic presentation. The objective of this study was to
evaluate the prevalence of significant abnormalities in radiographic findings performed on infants <24 months of age who were hospitalized
through the emergency department with the diagnosis of bronchiolitis, as well as to assess whether clinical variables can accurately identify
children with abnormal chest X-ray in order to reduce unnecessary radiation exposure.
Methods. From September 2006 to March 2007, infants aged <24 months evaluated and hospitalized through the emergency department
of the Hospital San Jose Tec de Monterrey with a diagnosis of bronchiolitis were included in the study. Clinical variables were registered
(age, gender, time since onset, oxygen saturation) and laboratory variables as well (leukocytes, lymphocytes, virus identified). Information
from the chest X-ray was also obtained.
Results. There were 128 patients included; 70% were aged <12 months. Chest X-ray was performed in 122 patients (95.31%) and respiratory
virus studies were done in 119 patients (92.96%). There were 69 patients who were positive (57.99%); respiratory syncytial virus was
demonstrated in 62 samples (89.85%) and 15 patients (12.29%) showed abnormal chest X-ray (atelectasis/consolidation). No differences
were found between patients with and without chest X-ray abnormalities in clinical and laboratory variables.
Conclusions. Most patients with bronchiolitis had a normal chest X-ray. Our study suggests that x-rays in children with typical bronchiolitis
have limited value.
REFERENCES
Coffin SE. Bronchiolitis: in-patient focus. Pediatr Clin North Am 2005;52:1047-1057.
American Academy of Pediatrics Guideline. Diagnosis and management of bronchiolitis. Pediatrics 2006;118:1774-1793.
Shay DK, Holman RC, Newman RD, Liu LL, Stout JW, Anderson LJ. Bronchiolitis-associated hospitalizations among US children, 1980-1996. JAMA 1999;282:1440-1446.
Smyth RL, Openshaw PJ. Bronchiolitis. Lancet 2006;368:312- 322.
Barr FE, Graham BS. Respiratory syncytial virus infection: clinical features and diagnosis. Disponible en: http:// www.uptodate.com/contents/respiratory-syncytial-virusinfection- clinical-features-and-diagnosis?source=search_ result&selectedTitle=1%7E150
Cane PA. Molecular epidemiology of respiratory syncytial virus. Rev Med Virol 2001;11:103-116.
Hall CB, Walsh EE, Long CE, Schnabel KC. Immunity to and frequency of reinfection with respiratory syncytial virus. J Infect Dis 1991;163:693-698.
American Academy of Pediatrics. Respiratory syncytial virus. En: Pickering, LK, ed. Red Book: Report of the Committee on Infectious Diseases. Elk Grove Village, IL: American Academy of Pediatrics; 2006. pp. 561.
Allander T, Jartti T, Gupta S, Niesters HG, Lehtinen P, Osterback R, et al. Human bocavirus and acute wheezing in children. Clin Infect Dis 2007;44:904-910.
Vogel AM, Lennon DR, Harding JE, Pinnock RE, Graham DA, Grimwood K, et al. Variations in bronchiolitis management between five New Zealand hospitals: can we do better? J Paediatr Child Health 2003;39:40-45.
Bordley WC, Viswanathan M, King VJ, Sutton SF, Jackman AM, Sterling L, et al. Diagnosis and testing in bronchiolitis: a systematic review. Arch Pediatr Adolesc Med 2004;158:119- 126.
Bourrillon A, David S, Vanhuxem CL, Dubus JC, Chabrol B. À propos des bronchiolites aigües du nourrisson [Management of acute bronchiolitis in infants]. Arch Pediatr 2004;11:709-711.
García-García ML, Calvo-Rey C, Quevedo-Teruel S, Martínez- Pérez M, Sánchez -Ortega F, Martín del Valle F, et al. Radiografía de tórax en la bronquiolitis: ¿es siempre necesaria? An Pediatr (Barc). 2004;61:219-225.
Christakis DA, Cowan CA, Garrison MM, Molteni R, Marcuse E, Zerr DM. Variation in inpatient diagnostic testing and management of bronchiolitis. Pediatrics 2005;115;878-884.
Dayan PS, Roskind CG, Levine DA, Kuppermann N. Controversies in the management of children with bronchiolitis. Clin Pediatr Emerg Med 2004;5:41-53.
Spurling GK, Fonseka K, Doust J, Del Mar C. Antibiotics for bronchiolitis in children. Cochrane Database Syst Rev 2007;1:CD005189.
Gadomski AM, Bhasale AL. Bronchodilators for bronchiolitis. Cochrane Database Syst Rev 2006;3:CD 001266.
Patel H, Platt R, Lozano JM, Wang EE. Glucocorticoids for acute viral bronchiolitis in infants and young children. Cochrane Database Syst Rev 2004;3:CD004878.
Gunn VL, Nechyba C, Johns Hopkins Hospital. Children´s Medical and Surgical Center. The Harriet Lane Handbook: A Manual for Pediatric House Officers. St. Louis: Mosby; 2002.
Wilson DF, Horn SD, Hendley JO, Smout R, Gassaway J. Effect of practice variation on resource utilization in infants hospitalized for viral lower respiratory illness. Pediatrics 2001;108:851-855.
Schuh S, Lalani A, Allen U, Manson D, Babyn P, Stephens D, et al. Evaluation of the utility of radiography in acute bronchiolitis. J Pediatr 2007;150:429-433.