Bronchiolitis-related ED visits by young children increased 26% from 2004-2018

From 2004 to 2018, bronchiolitis-related ED visits by children aged younger than 2 years in Ontario, Canada, increased, according to study results published in JAMA Pediatrics.

“Bronchiolitis ED visits in the US increased modestly from 2006 to 2010 from 35.6 to 36.3 per 1,000 person-years in children younger than 2 years, with a 24% increase in children aged 12 to 23 months,” Justin Brunet, MSc, research assistant in the Temerty Faculty of Medicine at the University of Toronto, and colleagues wrote. “Recent population-based studies of bronchiolitis ED use trends are lacking. Therefore, we conducted a study of bronchiolitis ED visits in Ontario, the most populous Canadian province providing universal publicly funded health coverage.”

Researchers conducted a population-based cohort study that included 2,336,446 children aged younger than 2 years (mean age, 8.4 months) with bronchiolitis ED encounters and hospitalizations from April 2004 to March 2018 in Ontario, Canada. Using linked provincial health administrative databases, researchers collected data on diagnosis codes, patient characteristics and bronchiolitis encounters.

The primary outcome was bronchiolitis ED visits per 1,000 person-years.

Among the 2.3 million children, 4% of children had 115,116 bronchiolitis ED encounters at 208 hospitals.

Bronchiolitis accounted for 3.4% of all-cause ED visits in 2004-2005 and 4.2% of all-cause ED visits in 2017-2018 (annual percent change [APC], 2.2%; P < .001).

Bronchiolitis ED visits increased 26.7%, from 27 per 1,000 person-years in 2004-2005 to 34.2 per 1,000 person-years in 2017-2018 (APC, 2.6%; P < .001).

Rates increased from 2004 to 2018 in subgroups by sex, age, gestational age, comorbidity, residence and socioeconomic status.

However, bronchiolitis ED hospitalizations decreased from 24.2 per 100 ED visits in 2004-2005 to 19.1 per 100 ED visits in 2017-2018, for a decrease of 21.1% (APC, -1.5%; P = .001).

Revisits for bronchiolitis remained stable during the study period (14 per 100 ED visits in 2004-2005; 11.8 per 100 ED visits in 2017-2018; APC, -0.3%; P = .68).

In addition, bronchiolitis mortality remained stable at 2.8% per 100,000 person-years from 2004 to 2018 (APC, 1.1%; P = .85).

“[The] increase in population-based bronchiolitis ED visits represents a growing health services burden of bronchiolitis on EDs. However, the decreasing bronchiolitis ED hospitalization rate and stable ED revisit and mortality rates suggest that illness severity did not increase. ... Future research is needed to examine reasons for the increase in bronchiolitis-related ED use to mitigate the implications for EDs, children and families,” the researchers wrote.