Treatment Patterns, Hospitalization Rate and Associating Factors of Bronchiolitis in Pediatric Emergency

Abstract

Introduction: Bronchiolitis is one of the most frequent causes of hospitalization in children under age of 2. Most evidence-based clinical bronchiolitis guidelines recommend minimal or no laboratory and instrumental tests and only supportive management. Aim: To evaluate treatment options and influencing factors of children referred to our university hospital pediatric emergency department (PED); to analyze hospitalization rate, and associated factors. Methods: Retrospective single center study was performed. Data of children < 2 years of age referred to PED from 2018 March to2019 June were included. Exclusion: lack of medical documentation, neonatal age. Demographic and clinical data, diagnostic and treatment options were evaluated. Results: In total, 268 children were included, 60% male. Majority were <6 months (n=181, 67.5%). 73 children had different risk factors, such as prematurity, cardiovascular diseases, etc. Most of the children complained of cough (n=240) without difference between the age or gender groups; wheezing was less frequent complaint on presentation (n=113). 50% of children had symptoms of RDS and younger children were more likely to present with RDS (39% from total; p<0.001). Obstruction was equally frequent in both age groups; however, crepitation was more commonly detected in younger children (121/181 versus 47/87; p=0.042). Most of the children were hospitalized and as expected, the majority were younger (138/181 as for <6 mo, 38/87 as for >6mo, p<0.001). None of the clinical factors except wheezing was associated with more frequent hospitalization rate (OR* 5.88, CI 95% 2.5-13.75 asfor wheezing; *adjusted for age, gender, risk group, RDS). Most of the children received inhalations with salbutamol (n=182) and 63 of all were prescribed glucocorticoids on arrival. 32 received antibiotics. Younger children presenting with RDS were more likely to get salbutamol inhalations (p<0.001). Children less than 6mo of age were more likely to receive supplementary oxygen (81% versus 19% of >6mo; p<0.001). As expected, children receiving O2 were more likely to be hospitalized (OR* 11.63, CI 95% 4.25-31.83). None of other treatment methods were associatedwith hospital admission. In a linear regression analysis, both supplementary O2 and antibiotics at ED were associated with longer LOS (OR 2.4 CI 95% 0.28-2.71 as for O2; OR 4.9 CI 95% 2.0-4.8 as for antibiotics). Conclusion: younger children with RDS were more likely to receive salbutamol inhalations. Children who presented with wheezing and those who received supplementary oxygen were more likely to be hospitalized. Receiving oxygen and antibiotics at ED was associated withlonger LOS.