OBJECTIVE: To carry out a cost-effectiveness analysis of omitting chest radiography in the diagnosis of infant bronchiolitis. HYPOTHESIS: Omitting chest radiographs in the diagnosis of typical bronchiolitis was expected to reduce costs without adversely affecting the detection rate of alternate diseases. STUDY DESIGN: An economic evaluation was conducted using clinical and health resources. Emergency department (ED) physicians provided diagnoses pre- and post-radiography as well as a management plan. The primary outcome was the diagnostic accuracy (false-negative rate) of alternate diagnoses with and without X-ray. The incremental costs of omitting radiography in comparison to routine radiography per patient were assessed from a health system perspective. PATIENT SELECTION: We studied 265 infants, 2-23 months old, presenting at the ED with typical bronchiolitis. Patients with pre-existing conditions or radiographs were omitted from the study. METHODOLOGY: Expected costs to the health care system of including and excluding chest radiographs were compared, including costs associated with misdiagnosis. RESULTS: All alternate diagnoses (two cases) were missed by ED physicians pre- and post-radiography, resulting in a 100% false negative rate. The specificity in detecting alternate diseases was 96.6% pre-radiography and 88.6% post-radiography. Of the 17 cases of coexistent pneumonia, 88% were missed pre-radiography and 59% post-radiography, with respective false positive rates of 10.5% and 16.1%. Omission of routine chest radiograph saved CDN $59 per patient, primarily due to savings in radiography and hospitalization costs. The economic benefit persisted after the inpatient length of stay, ED overhead and radiograph costs were varied. CONCLUSION: For infants with typical bronchiolitis, omitting radiography is cost saving without compromising diagnostic accuracy of alternate diagnoses and of associated pneumonia. (c) 2009 Wiley-Liss, Inc.
OBJECTIVE: To carry out a cost-effectiveness analysis of omitting chest radiography in the diagnosis of infantbronchiolitis. HYPOTHESIS: Omitting chest radiographs in the diagnosis of typical bronchiolitis was expected to reduce costs without adversely affecting the detection rate of alternate diseases. STUDY DESIGN: An economic evaluation was conducted using clinical and health resources. Emergency department (ED) physicians provided diagnoses pre- and post-radiography as well as a management plan. The primary outcome was the diagnostic accuracy (false-negative rate) of alternate diagnoses with and without X-ray. The incremental costs of omitting radiography in comparison to routine radiography per patient were assessed from a health system perspective. PATIENT SELECTION: We studied 265 infants, 2-23 months old, presenting at the ED with typical bronchiolitis. Patients with pre-existing conditions or radiographs were omitted from the study. METHODOLOGY: Expected costs to the health care system of including and excluding chest radiographs were compared, including costs associated with misdiagnosis. RESULTS: All alternate diagnoses (two cases) were missed by ED physicians pre- and post-radiography, resulting in a 100% false negative rate. The specificity in detecting alternate diseases was 96.6% pre-radiography and 88.6% post-radiography. Of the 17 cases of coexistent pneumonia, 88% were missed pre-radiography and 59% post-radiography, with respective false positive rates of 10.5% and 16.1%. Omission of routine chest radiograph saved CDN $59 per patient, primarily due to savings in radiography and hospitalization costs. The economic benefit persisted after the inpatient length of stay, ED overhead and radiograph costs were varied. CONCLUSION: For infants with typical bronchiolitis, omitting radiography is cost saving without compromising diagnostic accuracy of alternate diagnoses and of associated pneumonia. (c) 2009 Wiley-Liss, Inc.
Authors: Roi Piñeiro-Pérez; Carlos Ochoa-Sangrador; David López-Martín; Leticia Martínez-Campos; Cristina Calvo-Rey; Bruno José Nievas-Soriano Journal: Eur J Pediatr Date: 2022-09-14 Impact factor: 3.860
Authors: Emmanuelle Ecochard-Dugelay; Muriel Beliah; Caroline Boisson; Francis Perreaux; Jocelyne de Laveaucoupet; Philippe Labrune; Ralph Epaud; Hubert Ducou-Lepointe; Jean Bouyer; Vincent Gajdos Journal: PLoS One Date: 2014-05-02 Impact factor: 3.240
Authors: Libby Haskell; Emma J Tavender; Catherine Wilson; Franz E Babl; Ed Oakley; Nicolette Sheridan; Stuart R Dalziel Journal: BMC Pediatr Date: 2020-05-01 Impact factor: 2.125