Choosing Wisely:

Don’t order chest radiographs in children with uncomplicated asthma or bronchiolitis.

Rationale and Comments: National guidelines articulate a reliance on physical examination and patient history for diagnosis of asthma and bronchiolitis in the pediatric population. Multiple studies have established limited clinical utility of chest radiographs for patients with asthma or bronchiolitis. Omission of the use of chest radiography will reduce costs, but not compromise diagnostic accuracy and care.
Sponsoring Organizations:
  • Society of Hospital Medicine (Pediatric)
  • Sources:
  • National Heart, Lung and Blood Institute guidelines
  • American Academy of Pediatrics guidelines
  • Disciplines:
  • Pulmonary medicine
  • Pediatric
  • References: • American Academy of Pediatrics. Diagnosis and management of bronchiolitis. Pediatrics. 2006;118(4):1774-93.
    • National Heart, Lung and Blood Institute. Guidelines for the diagnosis and management of asthma. 2007. http://www.nhlbi.nih.gov/guidelines/asthma/.
    • Dawson, KP, et al. The chest radiograph in acute bronchiolitis. J Paediatr Child. 1990;26(4):209-11.
    • Roback MG, et al. Chest radiograph in the evaluation of first time wheezing episodes: review of current clinical efficacy. Pediatr Emerg Care. 1998;14(3):181-4.

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