Clinical Predictors of Chest Radiographic Abnormalities in Children Admitted with Bronchiolitis: A Single Center Study

Rationale: Chest radiography is often performed on patients when they are admitted with the diagnosis of bronchiolitis; however, it is unclear as to whether performing chest radiographs in patients with bronchiolitis at admission is useful. The aim of the present study was to determine clinical predictors of chest radiographic abnormalities, in children hospitalized with bronchiolitis in a general hospital.

Methods: All children admitted to our inpatient Pediatric Unit with an episode of acute bronchiolitis from January 2011 to December 2012 were included. The following data were collected at admission: sex, age, neonatal history, past history of hospitalization for respiratory illnesses, heart rate, respiratory rate, presence of fever, fever duration prior to admission, oxygen saturation, laboratory parameters (ie, complete blood cell count, C-reactive protein [CRP], etc) and chest radiography. Nasopharyngeal samples were collected in order to detect respiratory viruses by polymerase chain reaction.

Results: The study comprised 355 infants (median age 8 months, boys 60.8%, positive respiratory syncytial virus 23.9%). Among them, 33 children had a chest radiograph revealing focal opacity (n=30, 30.8%), or atelectasis (n=3, 3.8%). Multivariate logistic regression analysis showed that, after adjusting for potentially confounding factors, the clinical predictors of abnormal chest radiography findings in children hospitalized with bronchiolitis were low oxygen saturation levels (<95%) (adjusted odds ratio [aOR], 0.085; 95% confidence interval [CI], 0.043-0.167; p<0.001) and elevated CRP levels (aOR, 1.211; 95% CI, 1.060-1.384; p=0.005).

Conclusions: Among children admitted with bronchiolitis, chest radiographs may be necessary for children with low oxygen saturation (<95%) or high CRP levels at admission.