{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T14:33:01Z","timestamp":1781620381916,"version":"3.54.5"},"reference-count":48,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2016,10,3]],"date-time":"2016-10-03T00:00:00Z","timestamp":1475452800000},"content-version":"vor","delay-in-days":2,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2016,10]]},"abstract":"Abstract<\/jats:title>Background<\/jats:title>An abnormal chest X\u2010ray (CXR<\/jats:styled-content>) inconsistent with simple bronchiolitis is found in 7%\u201323% of cases. Despite national guidelines stating \u201ccurrent evidence does not support routine radiography in children with bronchiolitis\u201d; the use of CXR<\/jats:styled-content> in these patients remains high. Inappropriate use of CXR<\/jats:styled-content> not only exposes children to excess radiation, but also increases medical costs. The majority of the time, CXR<\/jats:styled-content>s are obtained to diagnose or rule out pneumonia. We aim to provide an evidence\u2010based approach defining the utility of CXR<\/jats:styled-content> in bronchiolitis for the diagnosis and treatment of bacterial pneumonia.<\/jats:p><\/jats:sec>Objectives<\/jats:title>We performed a systematic review and meta\u2010analysis to describe potential predictors of a CXR<\/jats:styled-content> with airspace disease in patients with bronchiolitis.<\/jats:p><\/jats:sec>Methods<\/jats:title>We searched the medical literature from 1965 to June 2015 in PubMed\/EMBASE<\/jats:styled-content> using the following PICO<\/jats:styled-content> formulation of our clinical question, \u201cWhat characteristic(s) of history\/physical examination (H&P) and vital signs (VS<\/jats:styled-content>) in a child with bronchiolitis should prompt the physician to order a CXR<\/jats:styled-content>?\u201d: Patients\u2014pediatric emergency department (ED<\/jats:styled-content>) patients (<2 years) with clinical bronchiolitis; Intervention\u2014H&P and VS<\/jats:styled-content>; Comparator\u2014a CXR<\/jats:styled-content> positive for airspace disease (+CXR<\/jats:styled-content>), defined as atelectasis versus infiltrate or infiltrate\/consolidation; and Outcome\u2014operating characteristics of H&P and VS<\/jats:styled-content> predicting an +CXR<\/jats:styled-content> were calculated: sensitivity, specificity, and likelihood ratios (LR<\/jats:styled-content>+ or LR<\/jats:styled-content>\u2212). The methodologic quality of the studies was assessed using the quality assessment of studies of diagnostic accuracy tool (QUADAS<\/jats:styled-content>\u20102). We created a test\u2013treatment threshold model based on the operating characteristics of the CXR<\/jats:styled-content> to accurately identify a child with bronchiolitis and a superimposed bacterial pneumonia while accounting for the risks of a CXR<\/jats:styled-content> and risks of treating patients with and without a bacterial infection.<\/jats:p><\/jats:sec>Results<\/jats:title>We found five studies including 1,139 patients meeting our inclusion\/exclusion criteria. Prevalence of a +CXR<\/jats:styled-content> ranged from 7% to 23%. An oxygen saturation < 95% was the predictor with highest LR<\/jats:styled-content>+ of 2.3 (95% confidence interval = 1.3 to 3.07) to predict a +CXR<\/jats:styled-content>. None of the H&P and VS<\/jats:styled-content> variables were found to have sufficiently low LR<\/jats:styled-content>\u2013 to significantly decrease the pretest probability of finding a +CXR<\/jats:styled-content>. Our test\u2013treatment threshold model showed that hypoxia (O2<\/jats:sub> Sat < 95%) alone complicating bronchiolitis did not show a benefit to obtaining a CXR<\/jats:styled-content>. Our model only suggested that a CXR<\/jats:styled-content> maybe indicated for a child with hypoxia (O2<\/jats:sub> Sat < 95%) and respiratory failure requiring ventilatory support.<\/jats:p><\/jats:sec>Conclusion<\/jats:title>No single predictor of a +CXR<\/jats:styled-content> was of sufficient accuracy to either support or refute ordering a CXR<\/jats:styled-content> in a child with clinical bronchiolitis. We provide a decision threshold model to estimate a test threshold for obtaining a CXR<\/jats:styled-content> and a treatment threshold for administering antibiotics. Application of this model requires the clinician to approximate the empiric benefit of antibiotics based on the clinical situation, highlighting the importance of clinical assessment.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acem.13052","type":"journal-article","created":{"date-parts":[[2016,7,18]],"date-time":"2016-07-18T07:35:54Z","timestamp":1468827354000},"page":"1107-1118","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Predictors of Airspace Disease on Chest X\u2010ray in Emergency Department Patients With Clinical Bronchiolitis: A Systematic Review and Meta\u2010analysis"],"prefix":"10.1111","volume":"23","author":[{"given":"Jennifer H.","family":"Chao","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine SUNY\u2010Downstate Medical Center Brooklyn NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raymond 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