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.