Chest Radiography in Children Hospitalized with Bronchiolitis

Wrotek, August; Czajkowska, Małgorzata; Jackowska, Teresa

doi:10.1007/5584_2019_435

Cited by 10 publications

(13 citation statements)

References 25 publications

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“…Several of these examinations already have established referral criteria or have recommendations against them in the Choosing Wisely list, however this review show that these are still being used in clinical practice, and more examinations might need referral guidelines. The most commonly practices reported as low-value was head CT in several clinical queries (especially related to minor head injury [ 20 – 33 , 36 , 37 , 40 – 53 , 55 , 56 , 286 – 293 ]), chest X-ray for routine checkup or follow-ups [ 78 – 113 , 118 – 120 , 339 – 343 ], trauma CT in patients without clinical symptoms or as repeat scans [ 227 – 232 , 287 , 314 – 322 ], and skeletal X-rays in non-traumatic pain or in fracture follow-ups [ 132 , 138 , 139 , 151 – 156 , 160 – 167 , 169 , 323 – 337 ]. The following were the most frequently reported low-value examinations: imaging in low back pain [ 121 – 131 ] and knee MRI without red flags [ 121 , 141 – 147 ], staging and follow-up in several types of cancer (X-ray, CT, MRI and nuclear medicine) [ 58 , 116 , 172 , 199 – 203 , 209 , 234 – 262 ], abdominal CT in self-limiting episode of suspected urolithiasis [ 190 , 204 – 206 ], chest CTA [ 210 – 216 ] and ultrasound lower limb veins in patients with low risk of thrombosis [ 217 – 221 ] were most prominent among adult populations.…”

Section: Discussionmentioning

confidence: 99%

Characterizing and quantifying low-value diagnostic imaging internationally: a scoping review

et al. 2022

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Background Inappropriate and wasteful use of health care resources is a common problem, constituting 10–34% of health services spending in the western world. Even though diagnostic imaging is vital for identifying correct diagnoses and administrating the right treatment, low-value imaging—in which the diagnostic test confers little to no clinical benefit—is common and contributes to inappropriate and wasteful use of health care resources. There is a lack of knowledge on the types and extent of low-value imaging. Accordingly, the objective of this study was to identify, characterize, and quantify the extent of low-value diagnostic imaging examinations for adults and children. Methods A scoping review of the published literature was performed. Medline-Ovid, Embase-Ovid, Scopus, and Cochrane Library were searched for studies published from 2010 to September 2020. The search strategy was built from medical subject headings (Mesh) for Diagnostic imaging/Radiology OR Health service misuse/Medical overuse OR Procedures and Techniques Utilization/Facilities and Services Utilization. Articles in English, German, Dutch, Swedish, Danish, or Norwegian were included. Results A total of 39,986 records were identified and, of these, 370 studies were included in the final synthesis. Eighty-four low-value imaging examinations were identified. Imaging of atraumatic pain, routine imaging in minor head injury, trauma, thrombosis, urolithiasis, after thoracic interventions, fracture follow-up and cancer staging/follow-up were the most frequently identified low-value imaging examinations. The proportion of low-value imaging varied between 2 and 100% inappropriate or unnecessary examinations. Conclusions A comprehensive list of identified low-value radiological examinations for both adults and children are presented. Future research should focus on reasons for low-value imaging utilization and interventions to reduce the use of low-value imaging internationally. Systematic review registration: PROSPERO: CRD42020208072.

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Section: Discussionmentioning

confidence: 99%

Characterizing and quantifying low-value diagnostic imaging internationally: a scoping review

et al. 2022

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“…Several studies showed low compliance with the recommendations ( Table 2 ) [ 14 , 22 , 44 , 45 , 46 , 47 , 48 , 49 ]. The use of bronchodilators was reported in more than 85% of patients in all studies; antibiotics were prescribed in 16% to 100% of patients, inhaled corticosteroids in 12.2% to 87.5%, and systemic corticosteroids in 6.1% to 55.7% of patients.…”

Section: Resultsmentioning

confidence: 99%

Respiratory Syncytial Virus Infections in Polish Pediatric Patients from an Expert Perspective

Borszewska-Kornacka,

Mastalerz-Migas,

Nitsch-Osuch

et al. 2023

Vaccines

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Respiratory syncytial virus (RSV) is the most common pathogen causing respiratory tract infections in infants, affecting over 90% of children within the first two years of life. It may cause lower respiratory tract infections, which constitute a significant healthcare burden both in the primary and secondary care settings. Meanwhile, the data regarding RSV disease in Poland is scarce, and published data significantly differs from the numbers reported for other countries with longstanding surveillance and reporting systems. A literature review and an expert panel were conducted to (1) understand the healthcare burden of RSV infections in Poland; (2) collect data on infection seasonality, patient pathway, and management patterns; and (3) evaluate RSV infection surveillance in Poland. According to the literature, RSV is the major agent responsible for non-influenza respiratory diseases in Poland. The reported rates of hospitalization for RSV infections are 267.5/100,000 for children under 5 years of age and 1132.1/100,000 for those under 1 year of age. Comparisons with data from other countries suggest that these values may be underestimated, possibly due to insufficient access to microbiological testing and a low awareness of RSV. Infections occur mainly between December and April, however, this pattern has changed following the implementation of preventive measures for coronavirus disease 2019 in the past few years. According to available reports, bronchodilators, antibiotics, corticosteroids, and X-ray imaging have been frequently used. The surveillance system in Poland has limitations, but these may be overcome due to recent changes in healthcare law as well as the availability and reimbursement of diagnostic tests.

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“…In the case of RSV, the huge discrepancies might be attributable to the clinical diagnosis of pneumonia; RSV is the most frequent cause of bronchiolitis, but chest X-ray reveals many minor abnormalities in patients diagnosed with RSV bronchiolitis, which are often diagnosed as pneumonia [ 45 , 46 , 47 ].…”

Section: Discussionmentioning

confidence: 99%

The Etiology of Community-Acquired Pneumonia Correlates with Serum Inflammatory Markers in Children

Wrotek

Robakiewicz²,

Pawlik³

et al. 2022

JCM

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Community-acquired pneumonia (CAP) severely affects pediatric hospitalizations. This study assessed the contribution of CAP to hospitalizations, its etiology in relationship with age, and the inflammatory markers. Between 2013 and 2018, 1064 CAP patients were hospitalized and diagnosed with bacterial/possibly bacterial pneumonia (BP), viral/possibly viral pneumonia (VP) and atypical pneumonia (AP). The etiology was confirmed using blood/pleural fluid culture/polymerase chain reaction (PCR), rapid antigen test/PCR in nasopharyngeal swabs, or serological studies. CAP accounted for 9.9% of hospitalizations and 14.8% of patient days. BP was diagnosed in 825 (77.5%), VP in 190 (17.9%), and AP in 49 (4.6%) cases; the confirmed etiology (n = 209; 20%) included mostly influenza (39%; n = 82), respiratory syncytial virus (RSV, 35%; n = 72), and Mycoplasma pneumoniae (19%; n = 39). VP frequency decreased with age (41% in < 3 mo to 9% in ≥ 60 mo), in contrast to AP (13% in ≥ 60 mo). Among the analyzed parameters, the best differentiating potential was shown by: C-reactive protein (CRP, AUCBP-VP = 0.675; 95% CI: 0.634–0.715), procalcitonin (AUCBP-AP = 0.73; 95% CI: 0.67–0.794), and CRP/procalcitonin (AUCAP-VP = 0.752; 95% CI: 0.67–0.83); a good positive predictive value (88.8%, 98.3%, and 91.6%, respectively) but a low negative predictive value (29.5%, 13.1%, and 40.7%, respectively) was observed. CAP influences hospital patient days more than the crude number of patients would suggest. On a clinical basis, BP is mainly recognized, although viral pneumonia is confirmed most often. RSV and influenza are responsible for a huge percentage of hospitalized cases, as well as M. pneumoniae in children aged ≥ 5 years. Serum inflammatory markers may help differentiate etiological factors.

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Chest Radiography in Children Hospitalized with Bronchiolitis

Cited by 10 publications

References 25 publications

Characterizing and quantifying low-value diagnostic imaging internationally: a scoping review

Characterizing and quantifying low-value diagnostic imaging internationally: a scoping review

Respiratory Syncytial Virus Infections in Polish Pediatric Patients from an Expert Perspective

The Etiology of Community-Acquired Pneumonia Correlates with Serum Inflammatory Markers in Children

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