Materials and Methods
This study was a retrospective cohort study performed at a tertiary
children’s hospital in the Southeastern US with annual ED visits of
74,000 before the pandemic. All emergency department visits for patients
under 24 months of age from March 2017 through February 2022 with an
ICD-10 diagnosis code for bronchiolitis (J.21) coded at any time during
their hospital stay. There were no exclusion criteria. Demographic
information including age, gender, race and ethnicity were collected
form the medical record. Visit information including acuity (based on
triage Emergency Severity Index level), disposition (admitted,
discharged, expired), admission unit, use of high flow nasal cannula,
albuterol, and chest radiographs during ED visit or after admission,
along with viral respiratory testing results were extracted. Viral
respiratory testing from nasopharyngeal swabs included three possible
panels that could be ordered at the prescriber’s discretion including a
viral respiratory panel (VRP) polymerase chain reaction that tested for
15 common viruses as well as Sars-CoV-2, RSV, and influenza antigen
detection, and a rapid BioFire® FilmArray® respiratory panel. Human
rhinovirus is not distinguished from other enteroviruses on these tests
and is reported as “rhino/enterovirus.” Data from the three years
prior to the pandemic (2017, 2018, 2019) were compared with “pandemic
years” 2020 and 2021. A year was a 12 month period from March to
February to help align with the emergence of COVID within the United
States in March of 2020.
Basic database management and analysis of descriptive statistics were
performed using Excel and SSPS statistical software. Comparisons of
differences among and within the 5 year study samples were accomplished
using the One Way ANOVA with post hoc pairwise multiple year comparisons
using Tukey’s HSD at alpha =0.05. For nonparametric group analyses,
Kruskal-Wallis ANOVA with the post hoc multiple group Bonferroni
correction with an alpha of 0.005 was used. Year to year comparisons of
the proportions of use of therapies, medications, orders or unit
specific admissions was performed using a 95% confidence interval
estimation of the differences of proportions (no continuity correction).
Intervals of the difference in proportions not inclusive of 0 were
considered statistically significant at p<0.05. This study was
approved by the University of Alabama at Birmingham Institutional Review
Board under exempt category four, protocol number IRB-300006644-004. The
datasets generated during and/or analyzed during the current study are
not publicly available, but are available from the corresponding author
on reasonable request.