So Laura, that's great that you went and searched the evidence, and
what did you find?
>> So first, I searched the term bronchiolitis and up to date.
>> Okay.
>> And I looked to see whether a chest x-ray helped with the diagnosis in
a patient like ours and I found that you could consider performing a chest x-ray
on a case by case basis, but I didn't really get a great answer to our question.
>> Okay.
>> So then I went and talked with Dr.
Smith, who is an attending physician in the paediatric intensive care unit.
>> Sure. >> And
he also said that sometimes a chest x-ray is helpful, but in other cases,
it's not and I also felt like I didn't get a solid answer to our question.
>> And he's certainly seen sicker patients than we do here on the floor.
>> Sure, that's true.
So finally, I went to the primary literature, and found this article.
>> What did you find?
>> Yeah, it says chest radio-graphs in infants hospitalized for
acute bronchiolitis.
Real information, or just a radiation?
>> Okay. >> And so what I found was that routine
chest radio-graphs may contribute to the treatment of infants hospitalized for
acute bronchiolitis, but it
says the indication of performing a chest radio-graph in infants hospitalized for
bronchiolitis should be discussed on a case by case basis again.
So again, I'm not really finding the answer that we're looking for.
>> You know what maybe we have to search in a different place.
Now Up to Date is a great resource but that is expert opinion and talking to
the paediatric ICU doctor is also a really good resource but unfortunately, they
see sicker patients than we do and a chest x-ray may be warranted a little bit more.
I think that's great that you went to the primary literature because the primary
literature is certainly a great resource but sometimes, it's hard and
this is not an incredibly large study and isn't exactly looking for what we want.
Have you ever heard of guidelines?
>> No I haven't.
>> So there are clinical guidelines for
a lot of the very common diseases that we see.
>> Okay. >> So I think that
that would be worth looking at.
So there are a couple of different resources.
One is that you could use guidelines.gov and we certainly could look there, but
I know that there's a really good guideline from the American Academy of
Paediatrics on Bronchiolitis, so why don't we search for it?
>> Great.
>> So if we go to pump med right here, and it has some search terms.
Now if we wanted to find guidelines for bronchialitis in our patient population
which is the infant, what kind of search terms would you like to use.
>> So probably bronchiolitis.
>> Okay.
>> Infants.
>> Okay.
>> Chest radiograph and diagnosis?
>> Exactly, I think that those would be great search terms, but
I think I'm going to try right now infants bronchiolitis, okay and diagnosis.
>> Okay.
>> And as you see, we're coming up right here with the American Academy of
Paediatrics Clinical Guidelines.
So, why don't we print out a copy and take a look.
>> Great. >> All right, great.
Sally Santen, M.D., Ph.D.Associate Professor - Emergency Medicine
