Bronchiolitis occurs with the viral infection of the lower respiratory tract, carrying with it a significant health burden among young children. According to the American Academy of Pediatrics (AAP) 2014 clinical practice guidelines, routine radiography in the evaluation of infants with bronchiolitis is not recommended, leading to unnecessary radiation exposure, antibiotic overuse and healthcare costs. In this repeated cross-sectional analysis, data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) was used to assess the proportion of infants diagnosed as having bronchiolitis who received radiography in the emergency department between 2007 and 2015. Between 2007 and 2015 there were 612 infants diagnosed with bronchiolitis (median age 8 months). The majority of cases presented to non-teaching, non-pediatric hospitals. Researchers found that the mean proportion of patients diagnosed with bronchiolitis with receipt of radiography was 46.1% (95% CI 39.5% to 52.8%). There was no change in the proportion of infants undergoing radiography by year (OR for year 0.99, 95% CI 0.91 to 1.08, p for trend=0.87). This study therefore shows that there has not been a decrease in radiography in patients with bronchiolitis, despite AAP guidelines, indicating that quality improvement initiatives are needed to translate bronchiolitis guidelines into practice.
Click to read the study in JAMA
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