In spite of guidelines recommending against routine x-rays for infants diagnosed with bronchitis, a new analysis of emergency department visits in the United States suggests there has been no decrease in x-ray utilization. Between 2007 and 2015, x-rays were still being used for nearly one-half of children aged two and under, according to research published in the Journal of the American Medical Association.
“Clinical practice guidelines of the American Academy of Pediatrics (AAP), published in 2006 and revised in 2014, recommend against routine radiography in the evaluation of infants with bronchiolitis,” wrote lead author Vijaya Kancherla, PhD, of the Emory University Rollins School of Public Health in Atlanta.
Unnecessary imaging for bronchitis, the authors noted, contributes to increased healthcare costs, radiation exposure and antibiotic overuse.
To better assess imaging usage in children, the researchers evaluated data from the National Hospital Ambulatory Medical Care Survey. Their analysis covered children aged two or younger who were admitted or discharged with a bronchitis diagnosis in the emergency department.
A total of 612 patients met the inclusion criteria. Approximately 59 percent were male, and the cohort had an average age of 8 months. Approximately 46 percent of these patients received radiography, which did not differ much from the 45 percent usage among all admitted children.
Kancherla et al. found no change in the proportion of infants undergoing radiography by year, but they did find “modest downward trends” in radiography use in studies conducted immediately after the AAP guidelines were issued. Higher rates of imaging were utilized in non-pediatric hospitals.
Some limitations of the study include a lack of clinical data to determine the appropriateness of radiographic imaging or the body location of imaging. Still, there is significant prevalence of radiography use among the demographic despite guidelines mandating the opposite.
“These results suggest that nationwide quality initiatives are still needed to translate bronchitis guidelines into practice,” the researchers wrote.
As a senior news writer for TriMed, Subrata covers cardiology, clinical innovation and healthcare business. She has a master’s degree in communication management and 12 years of experience in journalism and public relations.