Routine Chest X-Rays in Critical Bronchiolitis Do Not Improve Outcomes

<b>Background:</b> Routine chest X-rays (CXR) are not recommended by the American Academy of Pediatrics in bronchiolitis, yet remain a mainstay in diagnostics. We aimed to understand the impact of obtaining CXRs in patients with critical bronchiolitis, assessing intensive care unit length of stay (ICU-LOS) and intensive care unit level of respiratory support (ICU-LRS). <b>Methods/Design:</b> This single-center retrospective cohort study assessed children less than three years of age admitted to the PICU, pediatric step-down ICU, and pediatric cardiac ICU. Two groups were used for analysis: patients with CXR and no-CXR. The primary outcome was the difference in ICU-LOS and ICU-LRS between the groups. The critical bronchiolitis score (CBS) was used to calculate a predicted ICU-LOS and ICU-LRS. The secondary outcome was the difference between actual and predicted ICU-LOS and ICU-LRS, comparing the groups. <b>Results:</b> Of the 107 patients included, 65 patients (61%) received a CXR. Patients who received a CXR had significantly longer ICU-LOS (<i>p</i> = 0.01) and ICU-LRS (<i>p</i> = 0.02), despite no difference in predicted illness severity (ICU-LOS, <i>p</i> = 0.4; ICU-LRS, <i>p</i> = 0.3). The difference between actual and predicted ICU-LOS was greater in the no-CXR group (-1.4 days) compared to the CXR group (-0.8 days; <i>p</i> = 0.04). A similar trend was observed in ICU-LRS (-0.1 vs. -0.6 days; <i>p</i> = 0.1), though not statistically significant. <b>Conclusions:</b> Routine CXRs are common in critically ill bronchiolitis patients and may be associated with longer ICU-LOS and ICU-LRS, despite similar illness severity.