Key result
First year of COVID-19 linked to ~80% drop in bronchiolitis ED visits before summer 2021 resurgence.
Why the study?
COVID-19 disrupted typical patterns of viral transmission, prompting an evaluation of low-value care for bronchiolitis over time.
How did the COVID-19 pandemic alter the virology and resource utilization for bronchiolitis in the emergency department?
Cohort
No
How did the COVID-19 pandemic alter the virology and resource utilization for bronchiolitis in the emergency department?
Absolute Event Rate: 1% vs 3.1%
The COVID-19 pandemic drastically altered the epidemiology of bronchiolitis, leading to a temporary decrease in RSV cases, a shift toward rhinovirus with higher resource utilization, and an atypical summer resurgence of RSV.
May prompt adjusted ED surveillance for off-season bronchiolitis surges; leaves open drivers of post-pandemic RSV patterns.
BACKGROUND: Bronchiolitis is a viral respiratory illness most commonly caused by respiratory syncytial virus (RSV). COVID-19 disrupted typical patterns of viral transmission. Our study aimed to compare low value care for bronchiolitis in a tertiary emergency department (ED) in the United States from March 2017 to March 2022. METHODS: This was a descriptive cohort study through a retrospective chart review from 2017 to 2022 analyzing ED visits for bronchiolitis including disposition, disease severity, chest radiographs, albuterol, and high flow nasal cannula usage. A year was a 12-month period from March to February. RESULTS: From 2017 to 2020, there were over 2000 ED visits for bronchiolitis per year (3.1% of all ED visits), which decreased to 450 visits for bronchiolitis (1%) in 2020-2021. Human rhino/enterovirus was the most common virus detected (92%) at that time, and admission rates, albuterol, high flow nasal cannula, and chest radiographs were all higher. The summer of 2021 had the highest visits across the 5-study years with a return to previous rates of resource utilization. CONCLUSIONS: Bronchiolitis ED visits due to RSV dramatically reduced during the first year of the COVID-19 pandemic in 2020, with over 80% reduction in bronchiolitis visits from 2018 to 2019. While all ED visits fell in 2020, the proportion of visits due to bronchiolitis also decreased. There was an increase in lower value care during the rhinovirus dominant, low census period. As restrictions lifted in 2021, there was a large resurgence of RSV in the atypical summer months with a return of previous rates of resource utilization.
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Burks et al. (2023) conducted a cohort in Bronchiolitis. COVID-19 pandemic period (2020-2021) vs. Pre-pandemic period (2017-2020) was evaluated on Proportion of all emergency department visits due to bronchiolitis. The first year of the COVID-19 pandemic was associated with an over 80% reduction in bronchiolitis ED visits (decreasing from >2000 to 450 visits per year), followed by a resurgence in summer 2021.
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