Prospective Multicenter Study of the Viral Etiology of Bronchiolitis in the Emergency Department

Mansbach, Jonathan M.; McAdam, Alexander J.; Clark, Sunday; Hain, Paul D.; Flood, Robert G.; Acholonu, Uchechi; Camargo, Carlos A.

doi:10.1111/j.1553-2712.2007.00034.x

Cited by 112 publications

(101 citation statements)

References 42 publications

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“…Third, we did not perform chart reviews to identify patients with significant comorbidities or instances when the utilization of the tests or therapies was justified. We realize that bronchiolitis is a heterogeneous disease with different viral causes and a subset of patients may have benefited from further testing and/or therapies: for instance, patients with human rhinovirus-associated bronchiolitis have been shown to have a different clinical course 33 and may convey a higher risk of childhood asthma [34][35][36] than those with RSV-induced bronchiolitis. These patients could therefore benefit from further testing.…”

Section: Discussionmentioning

confidence: 99%

Impact of a Bronchiolitis Guideline on ED Resource Use and Cost: A Segmented Time-Series Analysis

et al. 2014

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OBJECTIVE: Bronchiolitis is a major cause of infant morbidity and contributes to millions of dollars in health care costs. Care guidelines may cut costs by reducing unnecessary resource utilization. Through the implementation of a guideline, we sought to reduce unnecessary resource utilization and improve the value of care provided to infants with bronchiolitis in a pediatric emergency department (ED). METHODS:We conducted an interrupted time series that examined ED visits of 2929 patients with bronchiolitis, aged 1 to 12 months old, seen between November 2007 and April 2013. Outcomes were proportion having a chest radiograph (CXR), respiratory syncytial virus (RSV) testing, albuterol or antibiotic administration, and the total cost of care. Balancing measures included admission rate, returns to the ED resulting in admission within 72 hours of discharge, and ED length of stay (LOS).RESULTS: There were no significant preexisting trends in the outcomes. After guideline implementation, there was an absolute reduction of 23% in CXR (95% confidence interval [CI]: 11% to 34%), 11% in RSV testing (95% CI: 6% to 17%), 7% in albuterol use (95% CI: 0.2% to 13%), and 41 minutes in ED LOS (95% CI: 16 to 65 minutes). Mean cost per patient was reduced by $197 (95% CI: $136 to $259). Total cost savings was $196 409 (95% CI: $135 592 to $258 223) over the 2 bronchiolitis seasons after guideline implementation. There were no significant differences in antibiotic use, admission rates, or returns resulting in admission within 72 hours of discharge.CONCLUSIONS: A bronchiolitis guideline was associated with reductions in CXR, RSV testing, albuterol use, ED LOS, and total costs in a pediatric ED. Pediatrics 2014;133:e227-e234 AUTHORS:

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Section: Discussionmentioning

confidence: 99%

Impact of a Bronchiolitis Guideline on ED Resource Use and Cost: A Segmented Time-Series Analysis

et al. 2014

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“…As a result, we could not evaluate the impact of viral etiology. 24 We also did not collect information on length of illness and could not incorporate this variable into our exploratory analysis on length of oxygen use. Finally, our results may be specific to high-altitude settings.…”

Section: Discussionmentioning

confidence: 99%

Outpatient Course and Complications Associated With Home Oxygen Therapy for Mild Bronchiolitis

et al. 2014

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BACKGROUND: Home oxygen has been incorporated into the emergency department management of bronchiolitis in high-altitude settings. However, the outpatient course on oxygen therapy and factors associated with subsequent admission have not been fully defined. METHODS: We conducted a retrospective cohort study in consecutive patients discharged on home oxygen from the pediatric emergency department at Denver Health Medical Center from 2003 to 2009. The integration of inpatient and outpatient care at our study institution allowed comprehensive assessment of follow-up rates, outpatient visits, time on oxygen, and subsequent admission. Admitted and nonadmitted patients were compared by using a χ2 test and multivariable logistic regression. RESULTS: We identified 234 unique visits with adequate follow-up for inclusion. The median age was 10 months (interquartile range [IQR]: 7–14 months). Eighty-three percent of patients were followed up within 24 hours and 94% within 48 hours. The median length of oxygen use was 6 days (IQR: 4–9 days), and the median number of associated encounters was 3 (range: 0–9; IQR: 2–3). Ninety-three percent of patients were on room air at 14 days. Twenty-two patients (9.4%) required subsequent admission. Fever at the initial visit (>38.0°C) was associated with admission (P < .02) but had a positive predictive value of 15.4%. Age, prematurity, respiratory rate, oxygen saturation, and history of previous bronchiolitis or wheeze were not associated with admission. CONCLUSIONS: There is a significant outpatient burden associated with home oxygen use. Although fever was associated with admission, we were unable to identify predictors that could modify current protocols.

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“…Mansbach ve ark. [8] RSV'den sonra en sık etkeninin rinovirüs olduğunu bildirmişlerdir. Bizim çalışmamızda ise tek etken olarak üreyen rinovirüs, RSV ile aynı sıklıkta görülmekle beraber çoklu etkenler içerisinde izole edilenlerle beraber rinovirüs oranı %33 ile ilk sıraya yükselmekteydi.…”

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Effects of Isolated Viral Pathogens and Treatment Strategies on the Course of Acute Bronchiolitis

Akin¹

2017

Haydarpasa Numune Med J

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Giriş ve Amaç: Akut bronşiyolit süt çocukluğunda ve 2 yaşından küçük çocuklarda, genellikle viral etkenlere bağlı gelişen ve hastaneye yatışın majör sebeplerinden olan bir alt solunum yolu enfeksiyonudur. Çalışmamızın amacı akut bronşiolit nedeniyle hastanede yatan çocuklarda izole edilen laboratuvar bulguları ve uygulanan tedavi yöntemlerinin hastaların yatış sürelerine etkisini araştırmaktır. Yöntem ve Gereçler: Bu amaçla Konya Eğitim ve Araştırma Hastanesi Çocuk Kliniğinde Aralık 2013 -Mayıs 2014 tarihleri arasında bronşiyolit tanısıyla yatarak takip edilen 95 hastanın dosyaları retrospektif olarak incelendi. Bulgular: En fazla izole edilen viral patojenler respiratuvar sinsityal virüs (%21.8) ve rinovirüs idi (%21.8). Sadece rinovirüs üreyen grupla üreme olmayan grup arasında yatış süreleri açısından anlamlı bir fark bulunamazken, sadece RSV-A üreyen ve RSV-A+Rinovirüs birlikte üreyen grupta hastanede yatış süreleri anlamlı derecede uzun bulundu. İnhale bronkodilatatör, ipratropium bromid, hipertonik salin tedavisi uygulanan ve uygulanmayan hasta grupları arasında yatış süreleri açısından anlamlı fark saptanmazken, inhale streoid alan olguların yatış süresi almayanlara oranla daha uzun bulundu. İmmunglobulin E (Ig E) düzeyi yüksek ölçülen hastaların ortalama yatış süreleri, normal olanlara göre anlamlı olarak uzundu. Anne sütü alan ve almayan gruplar arasında ve sigara ile temas öyküsü olan ve olmayan gruplar arasında yatış süreleri açısından anlamlı fark saptanmadı. Tartışma ve Sonuç: Sonuç olarak, RSV ve rinovirüs hala akut bronşiyolitin majör sebepleridir. İnhale steroid tedavisi almak, yüksek Ig E düzeyi ve bronşiolit sebebinin RSV olması hastanede yatış süresini uzatmaktadır. Anahtar sözcükler: Akut bronşiyolit virüs; çocuk; inhale tedaviler; yatış süresi. Effects of Isolated Viral Pathogens and Treatment Strategies in the Course of Acute BronchiolitisAbstract Introduction: Acute bronchiolitis, is predominantly a viral disease, part of the spectrum of lower respiratory tract diseases, and is a major cause of illness and hospitalization in infants and children younger than 2 years of age. The aim of the present study was to determine the effects of treatment protocols, other laboratory results, and isolated viral agents on the duration of hospitalization. Methods: Data of 95 children who were hospitalized with the diagnosis of bronchiolitis at the pediatrics clinic of Konya

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Prospective Multicenter Study of the Viral Etiology of Bronchiolitis in the Emergency Department

Cited by 112 publications

References 42 publications

Impact of a Bronchiolitis Guideline on ED Resource Use and Cost: A Segmented Time-Series Analysis

Impact of a Bronchiolitis Guideline on ED Resource Use and Cost: A Segmented Time-Series Analysis

Outpatient Course and Complications Associated With Home Oxygen Therapy for Mild Bronchiolitis

Effects of Isolated Viral Pathogens and Treatment Strategies on the Course of Acute Bronchiolitis

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