Abstract
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.
Highlights
Acute viral respiratory exacerbation is one of the most common conditions encountered in a paediatric emergency department (PED) during winter months [1]
The aims of our study were to investigate historical features and clinical examination findings in the evaluation of infants with bronchiolitis that conduct to the prescription of chest radiography (CR), and to determine clinical predictors of radiographic abnormalities
CR achievement Univariate analysis identified nine variables that were significantly related to the realisation of a chest radiography: age ≤ 3 months (p = 0.03), feeding difficulties (p < 0.001), fever (p < 0.001), tachypnea (p = 0.002), global score of respiratory distress (p < 0.001), hypoxia (SpO2 < 95%, p < 0.001), crackles (p < 0.001), bronchitis rales (p = 0.04) and toxic appearing (p = 0.04)
Summary
We aimed at defining clinical predictors of chest radiography prescription and radiographic abnormalities, among infants with bronchiolitis in a paediatric emergency department. Acute viral respiratory exacerbation is one of the most common conditions encountered in a paediatric emergency department (PED) during winter months [1]. The lack of reliable clinical decision rule for management of bronchiolitis often leads to perform chest radiography (CR) in order to detect radiographic abnormalities inconsistent with this diagnosis, such as pneumonia or other cardio-respiratory disease. The aims of our study were to investigate historical features and clinical examination findings in the evaluation of infants with bronchiolitis that conduct to the prescription of CR, and to determine clinical predictors of radiographic abnormalities
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