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Prospective Multicenter Study of the Viral Etiology of Bronchiolitis in the Emergency Department

  1. Jonathan M. Mansbach MD,
  2. Alexander J. McAdam MD, PhD,
  3. Sunday Clark MPH, ScD,
  4. Paul D. Hain MD,
  5. Robert G. Flood MD,
  6. Uchechi Acholonu BA,
  7. Carlos A. Camargo Jr. MD, DrPH

Article first published online: 7 FEB 2008

DOI: 10.1111/j.1553-2712.2007.00034.x

Issue

Academic Emergency Medicine

Academic Emergency Medicine

Volume 15, Issue 2, pages 111–118, February 2008

Additional Information

How to Cite

Mansbach, J. M., McAdam, A. J., Clark, S., Hain, P. D., Flood, R. G., Acholonu, U. and Camargo, C. A. (2008), Prospective Multicenter Study of the Viral Etiology of Bronchiolitis in the Emergency Department. Academic Emergency Medicine, 15: 111–118. doi: 10.1111/j.1553-2712.2007.00034.x

Author Information

  1. From the Department of Medicine (JMM) and the Department of Laboratory Medicine (AJM), Children’s Hospital Boston, Harvard Medical School, Boston, MA; the Department of Pediatrics, Vanderbilt Children’s Hospital (PDH), Nashville, TN; the Department of Pediatrics, Temple University School of Medicine (RGF), Philadelphia, PA; and the Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School (SC, UA, CAC), Boston, MA.

*Address for correspondence and reprints: Jonathan M. Mansbach, MD; e-mail: jonathan.mansbach@childrens.harvard.edu.

Publication History

  1. Issue published online: 7 FEB 2008
  2. Article first published online: 7 FEB 2008
  3. Received July 24, 2007; revision received October 3, 2007; accepted October 19, 2007.

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Keywords:

  • bronchiolitis;
  • respiratory syncytial virus;
  • rhinovirus;
  • asthma

Abstract

Objectives:  To determine the viral etiology of bronchiolitis and clinical characteristics of children age < 2 years presenting to the emergency department (ED) with bronchiolitis.

Methods:  The authors conducted a 14-center prospective cohort study during 2005–2006 of ED patients age < 2 years with bronchiolitis. The study was conducted in 10 states as part of the Emergency Medicine Network. Researchers collected nasopharyngeal aspirates and conducted structured interviews, medical record reviews, and 2-week follow-up telephone calls. Samples were tested using reverse transcription polymerase chain reaction for respiratory syncytial virus (RSV), rhinovirus (RV), human metapneumovirus (hMPV), and influenza viruses (Flu).

Results:  Testing of 277 samples revealed 176 (64%) positive for RSV, 44 (16%) for RV, 26 (9%) for hMPV, 17 (6%) for Flu A, and none for Flu B. When children were categorized as RSV only, RV only, RV and RSV, and all others (hMPV, Flu, no identified virus), children with RV only were more likely to be African American (19, 62, 14, and 40%, respectively; p < 0.001) and have a history of wheezing (23, 52, 21, and 15%, respectively; p = 0.01). In multivariate models, children with RV were more likely to receive corticosteroids (odds ratio [OR] 3.5; 95% confidence interval [CI] = 1.5 to 8.15). The duration of illness may be shorter for children with RV (Days 8, 3, 6, and 8; p = 0.07).

Conclusions:  In this multicenter study, RSV was the most frequent cause of bronchiolitis (64%). RV was present in 16%, and these children have a distinct profile in terms of demographics, medical history, and ED treatment.

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