Introduction
Bronchiolitis is a common disease affecting children from infancy to 24
months with inflammation and mucous production in the distal bronchioles
that can progress to significant respiratory distress [1-3]. It is
most commonly due to respiratory syncytial virus (RSV) but can be caused
by numerous other viruses including human rhinovirus, metapneumovirus,
influenza, adenovirus, coronavirus, and parainfluenza virus [3-5].
Bronchiolitis is the most common cause of hospitalizations for infants
less than 12 months of age and incurs a large financial burden on the
United States health system at over $400 million dollars per year [3,
6]. According to the Centers for Disease Control, traditionally RSV
peaks in December through March in North America with some regional
variations. The treatment is largely supportive, and guidelines
recommend against routine use of chest radiographs, albuterol, steroids,
and corticosteroids [1]. More recently, evidence does not support
early use of high flow nasal cannula in mild to moderate bronchiolitis
[Franklin 7, Keprotes 8]. Despite these guidelines, use is
widespread and recently was the target of a national quality improvement
project [Byrd 9].
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 or COVID-19)
developed in late 2019 and quickly spread globally in the spring of
2020, causing a worldwide pandemic [10]. Many measures and practices
were put in place to try to slow the spread including social distancing,
increased hand hygiene, face coverings in public places, “Stay at Home
Orders”, and mandatory closures of many businesses and schools. Early
on in the pandemic, emergency departments saw a significant decline in
patient encounters, including a decline in pediatric visits for
respiratory complaints [11]. A sharp decline in bronchiolitis was
noted in the Southern Hemisphere while COVID-19 cases were rising
[12]. A decrease in RSV cases continued worldwide during the first
year of the pandemic in 2020 to early 2021 [4, 12-15]. Previous
studies have focused on all emergency department (ED) visits or just
inpatient visits during the pandemic, but there is a lack of information
about changing patterns of bronchiolitis ED visits after more recent
rebounds, as well as how the changing volumes affect typical emphasis of
decreasing low value interventions.
This descriptive study aimed to compare bronchiolitis visits at a large
tertiary care pediatric ED in the southeast United States after the
onset of COVID-19 compared to the three years prior. Secondary aims
included comparing markers of visit acuity, virology, resource
utilization and general demographics of the study population to
determine if bronchiolitis ED visits consumed more resources after the
onset of the pandemic.