Bronchiolitis in US emergency departments 1992 to 2000: epidemiology and practice variation

Pediatr Emerg Care. 2005 Apr;21(4):242-7. doi: 10.1097/01.pec.0000161469.19841.86.

Abstract

Objective: To describe the epidemiology of US emergency department (ED) visits for bronchiolitis, including the characteristics of children presenting to the ED and the variability in bronchiolitis care in the ED.

Methods: Data were obtained from the 1992 to 2000 National Hospital Ambulatory Medical Care Survey. Cases had International Classification of Diseases, Ninth Revision, Clinical Modification code 466 and were younger than 2 years. National estimates were obtained using assigned patient visit weights; 95% confidence intervals were calculated using the relative standard error of the estimate; analysis used chi2 and logistic regression.

Results: From 1992 to 2000, bronchiolitis accounted for approximately 1,868,000 ED visits for children younger than 2 years. Among this same age group, the overall rate was 26 (95% confidence interval 22-31) per 1000 US population and 31 (95% confidence interval 26-36) per 1000 ED visits. These rates were stable over the 9-year period. Comparing children with bronchiolitis to those presenting with other problems, children with bronchiolitis were more likely boys (61% vs. 53%; P = 0.01) and Hispanic (27% vs. 20%; P = 0.008). Therapeutic interventions varied and 19% were admitted to the hospital. The multivariate predictor for receiving systemic steroids was urgent/emergent status at triage (odds ratio 4.0, 1.9-8.4). Multivariate predictors for admission were Hispanic ethnicity (odds ratio 2.3, 1.1-5.0) and urgent/emergent status at triage (odds ratio 3.7, 2.0-6.9).

Conclusions: ED visit rates for bronchiolitis among children younger than 2 years were stable between 1992 and 2000. The observed ED practice variation demonstrates that children are receiving medications for which there is little supporting evidence. Boys and Hispanics are at-risk groups for presentation to the ED, and Hispanics are more likely to be hospitalized.

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use
  • Adrenergic beta-Agonists / therapeutic use
  • Age Distribution
  • Anti-Bacterial Agents / therapeutic use
  • Bronchiolitis / diagnostic imaging
  • Bronchiolitis / epidemiology*
  • Bronchiolitis / therapy*
  • Child, Preschool
  • Confidence Intervals
  • Continental Population Groups / statistics & numerical data
  • Emergency Medicine / statistics & numerical data*
  • Emergency Service, Hospital / statistics & numerical data*
  • Female
  • Geography
  • Health Care Surveys
  • Health Surveys
  • Hospitalization / statistics & numerical data
  • Humans
  • Infant
  • Infant, Newborn
  • Insurance, Health / statistics & numerical data
  • Logistic Models
  • Male
  • Multivariate Analysis
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Prevalence
  • Radiography
  • Retrospective Studies
  • Seasons
  • Sex Distribution
  • United States / epidemiology

Substances

  • Adrenal Cortex Hormones
  • Adrenergic beta-Agonists
  • Anti-Bacterial Agents