Do chest computed tomography and radiography influence clinical management in children with cystic fibrosis

Objectives: Can chest computed tomography (CT) or radiography (CR) at routine follow--up change clinical management in children with stable cystic fibrosis (CF)? Methods: 36 patients randomly selected from 2 Dutch CF centers were translated into anonymized standardized web-based clinical cases. European and Australian clinicians were asked to suggest therapeutic and diagnostic management in a set of 10 clinical cases through a web presentation. In a cross-over design, the same cases were presented again after a 10-week interval. 50% cases were presented with and without CT (CT+/CT-), and 50% were presented with and without CR (CR+/CR-). Clinicians were not aware of study aim. Analysis was performed using McNemar test. Results: 44 clinicians from 25 CF centers (response rate 78%) completed 143 CT+/CT- cases and 167 CR+/CR- cases in duplo. Of the recruited clinicians, 89% was >35 years old. The presence of CT was associated with a significant increase in oral antifungals (OR 2.75, p=0.02), bronchoscopy (OR 1.63, p=0.04), and the predefined combined outcomes IV antibiotics + bronchoscopy (i.e. need for hospitalization) (OR 1.28, p=0.03) and bronchoscopy + mycobacterial culture (OR 1.24, p=0.02). Presence of CR was associated with a significant increase in inhaled antibiotics only (OR 1,28, p=0.04). We found considerable variations in the treatment of children with CF across Europe and Australia. Conclusion: CT at routine follow-up evaluations was associated with significant changes in clinical management, most notably increase in bronchoscopies. CR was not associated with significant changes in clinical management.