Document Detail


Evaluation of the utility of radiography in acute bronchiolitis.
MedLine Citation:
PMID:  17382126     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: To determine the proportion of radiographs inconsistent with bronchiolitis in children with typical presentation of bronchiolitis and to compare rates of intended antibiotic therapy before radiography versus those given antibiotics after radiography. STUDY DESIGN: We conducted a prospective cohort study in a pediatric emergency department of 265 infants aged 2 to 23 months with radiographs showing either airway disease only (simple bronchiolitis), airway and airspace disease (complex bronchiolitis), and inconsistent diagnoses (eg, lobar consolidation). RESULTS: The rate of inconsistent radiographs was 2 of 265 cases (0.75%; 95% CI 0-1.8). A total of 246 children (92.8%) had simple radiographs, and 17 radiographs (6.9%) were complex. To identify 1 inconsistent and 1 complex radiograph requires imaging 133 and 15 children, respectively. Of 148 infants with oxygen saturation >92% and a respiratory disease assessment score <10 of 17 points, 143 (96.6%) had a simple radiograph, compared with 102 of 117 infants (87.2%) with higher scores or lower saturation (odds ratio, 3.9; 95% CI, 1.3-14.3). Seven infants (2.6%) were identified for antibiotics pre-radiography; 39 infants (14.7%) received antibiotics post-radiography (95% CI, 8-16). CONCLUSIONS: 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.
Authors:
Suzanne Schuh; Amina Lalani; Upton Allen; David Manson; Paul Babyn; Derek Stephens; Shannon MacPhee; Matthew Mokanski; Svetlana Khaikin; Paul Dick
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Publication Detail:
Type:  Comparative Study; Evaluation Studies; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The Journal of pediatrics     Volume:  150     ISSN:  1097-6833     ISO Abbreviation:  J. Pediatr.     Publication Date:  2007 Apr 
Date Detail:
Created Date:  2007-03-26     Completed Date:  2007-04-11     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0375410     Medline TA:  J Pediatr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  429-33     Citation Subset:  AIM; IM    
Affiliation:
Division of Paediatric Emergency Medicine, Department of Pediatrics, Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. suzanne.schuh@sickkids.on.ca
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Anti-Bacterial Agents / therapeutic use
Bronchiolitis / drug therapy,  radiography*
Cohort Studies
Drug Utilization
Female
Follow-Up Studies
Humans
Infant
Male
Prospective Studies
Sensitivity and Specificity
Chemical
Reg. No./Substance:
0/Anti-Bacterial Agents

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