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Pediatric Infectious Disease Journal:
doi: 10.1097/INF.0b013e3182a5f324
Original Studies

Temporal Trends in Emergency Department Visits for Bronchiolitis in the United States, 2006 to 2010

Hasegawa, Kohei MD, MPH*†; Tsugawa, Yusuke MD, MPH†‡§; Brown, David F. M. MD*†; Mansbach, Jonathan M. MD, MPH‡¶; Camargo, Carlos A. MD, DrPH*†

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Abstract

Background:

To examine temporal trends in emergency departments (EDs) visits for bronchiolitis among US children between 2006 and 2010.

Methods:

Serial, cross-sectional analysis of the Nationwide Emergency Department Sample, a nationally representative sample of ED patients. We used International Classification of Diseases, Ninth Revision, Clinical Modification code 466.1 to identify children <2 years of age with bronchiolitis. Primary outcome measures were rate of bronchiolitis ED visits, hospital admission rate and ED charges.

Results:

Between 2006 and 2010, weighted national discharge data included 1,435,110 ED visits with bronchiolitis. There was a modest increase in the rate of bronchiolitis ED visits, from 35.6 to 36.3 per 1000 person-years (2% increase; Ptrend = 0.008), due to increases in the ED visit rate among children from 12 months to 23 months (24% increase;Ptrend < 0.001). By contrast, there was a significant decline in the ED visit rate among infants (4% decrease; Ptrend < 0.001). Although unadjusted admission rate did not change between 2006 and 2010 (26% in both years), admission rate declined significantly after adjusting for potential patient- and ED-level confounders (adjusted odds ratio for comparison of 2010 with 2006, 0.84; 95% confidence interval: 0.76–0.93; P < 0.001). Nationwide ED charges for bronchiolitis increased from $337 million to $389 million (16% increase; Ptrend < 0.001), adjusted for inflation. This increase was driven by a rise in geometric mean of ED charges per case from $887 to $1059 (19% increase; Ptrend < 0.001).

Conclusions:

Between 2006 and 2010, we found a divergent temporal trend in the rate of bronchiolitis ED visits by age group. Despite a significant increase in associated ED charges, ED-associated hospital admission rates for bronchiolitis significantly decreased over this same period.

Copyright © 2014 by Lippincott Williams & Wilkins

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