Trends in Bronchiolitis Hospitalizations in the United States, 2000–2009

Abstract

OBJECTIVE: To examine temporal trend in the national incidence of bronchiolitis hospitalizations, use of mechanical ventilation, and hospital charges between 2000 and 2009. METHODS: We performed a serial, cross-sectional analysis of a nationally representative sample of children hospitalized with bronchiolitis. The Kids Inpatient Database was used to identify children <2 years of age with bronchiolitis by International Classification of Diseases, Ninth Revision, Clinical Modification code 466.1. Primary outcome measures were incidence of bronchiolitis hospitalizations, mechanical ventilation (noninvasive or invasive) use, and hospital charges. Temporal trends were evaluated accounting for sampling weights. RESULTS: The 4 separated years (2000, 2003, 2006, and 2009) of national discharge data included 544 828 weighted discharges with bronchiolitis. Between 2000 and 2009, the incidence of bronchiolitis hospitalization decreased from 17.9 to 14.9 per 1000 person-years among all US children aged <2 years (17% decrease; Ptrend < .001). By contrast, there was an increase in children with high-risk medical conditions (5.9%–7.9%; 34% increase; Ptrend < .001) and use of mechanical ventilation (1.9%–2.3%; 21% increase; Ptrend = .008). Nationwide hospital charges increased from $1.34 billion to $1.73 billion (30% increase; Ptrend < .001); this increase was driven by a rise in the geometric mean of hospital charges per case from $6380 to $8530 (34% increase; Ptrend < .001). CONCLUSIONS: Between 2000 and 2009, we found a significant decline in bronchiolitis hospitalizations among US children. By contrast, use of mechanical ventilation and hospital charges for bronchiolitis significantly increased over this same period.

3% Hypertonic Saline Versus Normal Saline in Inpatient Bronchiolitis: A Randomized Controlled Trial

“…The primary limitation of this study was its single-center nature, raising the question of generalizability; however, LOS was comparable to other US studies on bronchiolitis, 3,15 and our results may be applicable to other urban centers with a diverse patient population. Second, enrolling patients within a 12-hour window from time of admission rather than on presentation could influence duration of time patients are in the study, especially for patients with a shorter LOS.…”

“…Although we did not find that HS decreased LOS, we also did not find an increase in adverse events, including in a post hoc subgroup analysis (limited by being Bronchiolitis admissions consume substantial US health care resources, surpassing $1.7 billion annually in charges. 3 It is imperative that research focus on using effective treatments for these infants, minimizing bothersome interventions without benefit. Our negative study may help reduce use of HS and thereby decrease hospitalization costs and unnecessary resource utilization.…”

“…[1][2][3] Total inpatient charges exceed $1.7 billion annually and mean length of stay (LOS) is 2.4 days. 3 Treatment of this common and costly condition is mainly supportive, as previous studies suggest little benefit from bronchodilators, 4,5 antibiotics, 6 or steroids. 7,8 Some suggest nebulized 3% sodium chloride, hypertonic saline (HS), is helpful, 9-14 but results are contradictory.…”

The Fecal Microbiota Profile and Bronchiolitis in Infants

“…[1][2][3] Indeed, bronchiolitis is the leading cause of hospitalizations in US infants, accounting for 18% of all infant hospitalizations. 3 Although causative viral pathogens (eg, respiratory syncytial virus [RSV]) are ubiquitous, not all infants develop bronchiolitis. 4 Likewise, severity of infection ranges from a minor nuisance to fatal bronchiolitis.…”

Effectiveness of Quality Improvement in Hospitalization for Bronchiolitis: A Systematic Review

“…1 Bronchiolitis causes nearly 20% of all acute care hospitalizations for children aged ,1 year in the United States. 2 The disease generally occupies 1 of the top 3 spots for inpatient medical expenditures in young children annually, and costs are continuing to rise. Unfortunately, despite the high volume and significant economic impact of the disease, clinical trials have failed to establish any specific therapy as effective; therefore, supportive care is the mainstay of an evidencebased approach to the disease.…”