ABSTRACT
AimsTo compare practice of investigating and managing children presenting with clinical features of bronchiolitis against hospital guidelines.MethodsPatients were identified using HIPE database. 129 patients presented with clinical features suggesting bronchiolitis over the 12 month audit period i.e., between 01/06/2019 and 31/05/2020. Out of these, 62 patients were randomly selected for further analysis. Data were collected using the audit tool and analyzed using Microsoft Excel.Results62 patients were selected for audit. Male to female ratio was 1.4:1. Age distribution: 0-3 months: 50%, 3-6 months: 22%, 6-24 months: 27%. 38% (24/62) were classified as mild, 46% (29/62) as moderate, and 14% (9/62) as severe bronchiolitis. Alternative diagnoses considered were: LRTI not specified: 21%, Sepsis 8%, UTI 1.6%, Pertussis 1.6%, BRUE 1.6%, Influenza B 1.6%, GORD 1.6%. 80% (50/62) of patients were hospitalized. Mean duration of hospital stay was 3.3 days. In terms of investigations, 40% had bloods or swabs or both taken, 32% had chest x-rays, and 8% had ECGs performed. Out of the 11 swabs performed, 6 were RSV positive, 1 COVID positive and 1 Influenza B positive. From the management point of view, 26% (16/62) received antibiotic treatment, 42% (26/62) required oxygen support, and 23% (14/62) received salbutamol/ipratropium nebulization. 10% (6/62) required respiratory support while 3.2% (2/62) were transferred to ICU. Complications included pneumonia in 10%, lung collapse in 6.5% and re-admission in 22%.ConclusionOverall clinical approach to children with bronchiolitis was in line with the guidelines. However, a significant percentage of patients underwent unnecessary investigations and treatments. Antibiotics were prescribed in a high percentage (26%) of cases. Moreover, the hospitalization and re-admission rates were significantly high. A clinical assessment tool made readily available in ED may help in improving the assessment and management of these patients.