Radiography Still Common in Pediatric Bronchiolitis Despite AAP Guidelines

Chest X-ray of an infant
Chest X-ray of an infant
Despite recommendations made by the American Academy of Pediatrics, the use of radiography in pediatric bronchiolitis has not decreased.

Despite recent recommendations by the American Academy of Pediatrics (AAP), the use of radiography did not decrease between 2007 and 2015, according to a study published in the Journal of the American Medical Association. Researchers found that almost half of bronchiolitis cases resulted in radiography, a trend more common at nonpediatric facilities.

This repeated, cross-sectional analysis included data from the National Hospital Ambulatory Medical Care Survey, in which there were 612 (1.1% of all 269,721 visits in the survey) bronchiolitis-related emergency department visits for children <18 years old from 2007 to 2015. Of these patients, most went to hospitals that were nonpediatric and nonteaching, and 46.1% (95% CI, 39.5%-52.8%) received radiography.

Multivariable analysis showed the rate of radiography administered to infants did not vary by year (P =.87), with an adjusted odds ratio for change by year of 0.99 (95% CI, 0.91-1.08). The admittance rate was 10.3% among visits to emergency departments. Those discharged showed a similar radiography rate of 46.2% (95% CI, 39.4%-53.2%) compared with 44.8% (95% CI, 29.2%-61.6%; P =.83) in those admitted. Imaging was more common in children whose race was not black or white and in nonpediatric hospitals.

Of the 612 cases of interest, 58.8% were male, 66.9% were white, and the median age was 8 months. The dataset included approximately 30,000 visits to a random selection of 300 emergency departments in the United States. The researchers used survey-weighting methods were used to approximate total and subgroup radiography rates. In addition, the researchers used multivariable logistic regression to adjust for covariates in patients and emergency departments and a Pearson χ2 test to examine trends.

 “[N]o decrease in radiography was observed between 2007 and 2015, despite AAP bronchiolitis guidelines in 2006 and 2014 and Choosing Wisely recommendations in 2013. Modest downward trends in radiography use were found in studies conducted immediately following AAP guidelines and among admitted patients at pediatric centers,” the researchers concluded. “Assuming study visits can be projected to reflect the US population, there would have been an estimated 2.92 million pediatric ED visits for bronchiolitis over the 9-year study period.”

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Disclosures: Dr Papenburg reports financial relationships with several pharmaceutical companies. For a full list of disclosures, please visit the reference.


Burstein B, Plint AC, Papenburg J. Use of radiography in patients diagnosed as having acute bronchiolitis in US emergency departments, 2007-2015. JAMA. 2018;320(15):1598-1600. doi:10.1001/jama.2018.9245