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With input from several medical societies, the American Academy of Pediatrics recently published a clinical guideline for diagnosing and treating bronchiolitis (Journal Watch Pediatrics and Adolescent Medicine Jan 10 2007). Although the guideline discourages the routine use of chest x-rays in bronchiolitis, they are still widely used in practice.
In this prospective cohort study from a children’s hospital in Toronto, 265 previously healthy children (age range, 2–23 months) with typical signs and symptoms of bronchiolitis had a chest x-ray after two to three nebulization treatments. In only two infants were the x-rays read as inconsistent with bronchiolitis; one child had a lobar consolidation, and the other had cardiomegaly. Ninety-three per…