Department of Pediatrics, Section of Pediatric Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Hosp Pediatr. 2024 Jan 1;14(1):59-66. doi: 10.1542/hpeds.2023-007359.
Bronchiolitis and asthma have similar acute clinical presentations in young children yet have opposing treatment recommendations. We aimed to assess the role of age and other factors in the diagnosis of bronchiolitis and asthma in children <24 months of age.
We conducted a retrospective cross-sectional analysis of the Pediatric Health Information System database. We included children aged <2 years diagnosed with bronchiolitis, asthma, wheeze, or bronchospasm in emergency department or hospital encounters from 2017 to 2021. We described variation by age and between institutions. We used mixed-effects models to assess factors associated with a non-bronchiolitis diagnosis in children 12 to 23 months of age.
We included 554 158 encounters from 42 hospitals. Bronchiolitis made up 98% of encounters for children <3 months of age, whereas asthma diagnoses increased with age and were included in 44% of encounters at 23 months of age. Diagnosis patterns varied widely between hospitals. In children 12 to 23 months of age, the odds of a non-bronchiolitis diagnosis increased with month of age (odds ratio [OR] 1.13, 95% confidence interval [CI] 1.12-1.13), male sex (OR 1.37, 95% CI 1.35-1.40), non-Hispanic Black race (OR 1.54, 95% CI 1.50-1.58), number of previous encounters (OR 2.73, 95% CI 2.61-2.86, for 3 or more encounters), and previous albuterol use (OR 2.24, 95% CI 2.16-2.32).
Non-bronchiolitis diagnoses and the use of inhaled bronchodilators and systemic steroids for acute wheezing respiratory illness increase with month of age in children aged 0 to 23 months. Better definitions of clinical phenotypes of bronchiolitis and asthma would allow for more appropriate treatment in acute care settings, particularly in children 12 to 23 months of age.
毛细支气管炎和哮喘在幼儿中具有相似的急性临床特征，但治疗建议却截然相反。我们旨在评估年龄和其他因素在<24 个月龄儿童毛细支气管炎和哮喘诊断中的作用。
我们对儿科健康信息系统数据库进行了回顾性横断面分析。我们纳入了 2017 年至 2021 年在急诊科或医院就诊时被诊断为毛细支气管炎、哮喘、喘息或支气管痉挛的<2 岁儿童。我们描述了不同年龄和不同机构之间的差异。我们使用混合效应模型评估了 12 至 23 个月龄儿童中与非毛细支气管炎诊断相关的因素。
我们纳入了来自 42 家医院的 554158 次就诊。<3 个月龄儿童的就诊中，毛细支气管炎占 98%，而哮喘诊断随着年龄的增长而增加，在 23 个月龄时占 44%。医院之间的诊断模式差异很大。在 12 至 23 个月龄儿童中，非毛细支气管炎诊断的可能性随月龄增加而增加（优势比 [OR] 1.13，95%置信区间 [CI] 1.12-1.13），男性（OR 1.37，95%CI 1.35-1.40），非西班牙裔黑人种族（OR 1.54，95%CI 1.50-1.58），就诊次数（OR 2.73，95%CI 2.61-2.86，就诊 3 次及以上）和先前使用沙丁胺醇（OR 2.24，95%CI 2.16-2.32）。
在 0 至 23 个月龄儿童中，非毛细支气管炎诊断以及急性喘息性呼吸道疾病中吸入性支气管扩张剂和全身皮质类固醇的使用随月龄增加而增加。更好地定义毛细支气管炎和哮喘的临床表型将有助于在急性护理环境中进行更恰当的治疗，特别是在 12 至 23 个月龄的儿童中。
