Abstract:
Background: Bronchiolitis is a common lower respiratory tract infection in infants, typically managed clinically without the need for routine imaging. However, inappropriate use of chest X-rays (CXRs) persists, leading to unnecessary radiation exposure, potential overtreatment with antibiotics, with increased healthcare cost to the NHS. This audit aimed to assess adherence to Cwm Taf Morgannwg (CWM TAF) guidelines on CXR use in bronchiolitis at Prince Charles Hospital.
Standards: According to the CWM TAF guidelines, CXR should only be performed in bronchiolitis cases where there is diagnostic uncertainty, severe disease, or suspicion of complications.
Method: A retrospective audit was conducted in the paediatric ward at Prince Charles Hospital. Data were collected from case notes of children under 2 years admitted with bronchiolitis during:
- Cycle 1: November–December 2023 (n=15)
- Cycle 2: November–December 2024 (n=24)
For each patient, it was recorded whether a CXR was performed and whether it met guideline criteria. After the first cycle, a sticker-based intervention was introduced to reinforce specific indications for CXR use.
Results: In Cycle 1, 14 CXRs were performed:
- 10 were guideline-adherent (71.43%)
- 4 were non-adherent (28.57%)
In Cycle 2, 20 CXRs were performed:
- 14 were guideline-adherent (70.00%)
- 6 were non-adherent (30.00%)
Adherence to guidelines remained stable (~70%) across both cycles. A slight increase in non-adherence was observed (28.57% to 30.00%), though not clinically significant. The second cycle included a broader patient sample, suggesting improved documentation and clinical awareness.
Conclusion: The audit revealed consistent adherence to local guidelines in the majority of cases. Although the intervention did not reduce non-adherence rates, it may have contributed to increased awareness and broader clinical application. Further measures, such as repeated education and electronic prompts, may be needed to sustain and improve practice.
