Despite recommendations against using radiographs in the evaluation of bronchiolitis in infants, nearly one-half of cases diagnosed in American EDs are administered unneeded imaging, according to research published in JAMA.
“Clinical practice guidelines of the AAP, published in 2006 and revised in 2014, recommend against routine radiography in the evaluation of infants with bronchiolitis,” Brett Burstein, MDCM, PhD, MPH, assistant professor in the division of emergency medicine at McGill University, and colleagues wrote. “Unnecessary imaging for bronchiolitis contributes to health care costs, radiation exposure and antibiotic overuse and consequently was identified in 2013 as a national ‘Choosing Wisely’ priority.”
Burstein and colleagues examined how many infants were diagnosed with bronchiolitis between 2007 and 2015 and how many of these infants received a radiograph using data collected from the National Hospital Ambulatory Medical Care Survey. Children aged younger than 2 years presenting to 300 randomly selected EDs in the United States were included in the study.
The researchers identified 269.721 visits to the ED during the study. Bronchiolitis was diagnosed in 612 children aged younger than 18 years, with a median age of 8 months. On average, nearly half (46.1%) of all children with a bronchiolitis diagnosis were administered a radiograph. This proportion did not change between 2007 and 2015.
According to the researchers, 10.3% of patients presenting to the ED with bronchiolitis were admitted. When the researchers assessed patients who were discharged from the ED, 46.2% were administered a radiograph. Burstein and colleagues observed a similar rate of radiography use among admitted children.
Hospitals that were not specialized in pediatrics were more likely to administer radiographs, and infants who had a reported ethnicity other than black or white were more likely to receive a radiograph for bronchiolitis.
“Assuming study visits can be projected to reflect the U.S. population, there would have been an estimated 2.92 million pediatric ED visits for bronchiolitis over the 9-year study period,” the researchers wrote. “These results suggest that nationwide quality initiatives are still needed to translate bronchiolitis guidelines into practice.” – by Katherine Bortz
Disclosures: Burstein reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.