Skip to main content

Management of Bronchiolitis in Community Hospitals in Ontario: a Multicentre Cohort Study

  • Amy C. Plint (a1), Monica Taljaard (a2) (a3), Candice McGahern (a4), Shannon D. Scott (a5), Jeremy M. Grimshaw (a4) (a6), Terry P. Klassen (a7) and David W. Johnson (a8)...
Abstract Objectives

Bronchiolitis is the leading cause of hospital admission for infants, but few studies have examined management of this condition in community hospital settings. We reviewed the management of children with bronchiolitis presenting to community hospitals in Ontario.


We retrospectively reviewed a consecutive cohort of infants less than 12 months old with bronchiolitis who presented to 28 Ontario community hospitals over a two-year period. Bronchiolitis was defined as first episode of wheezing associated with signs of an upper respiratory tract infection during respiratory syncytial virus season.


Of 543 eligible children, 161 (29.7%, 95% Confidence Interval (CI) 22.3 to 37.0%) were admitted to hospital. Hospital admission rates varied widely (Interquartile Range 0%-40.3%). Bronchodilator use was widespread in the emergency department (ED) (79.7% of patients, 95% CI 75.0 to 84.5%) and on the inpatient wards (94.4% of patients, 95% CI 90.2 to 98.6%). Salbutamol was the most commonly used bronchodilator. At ED discharge 44.7% (95% CI 37.5 to 51.9%) of patients were prescribed a bronchodilator medication. Approximately one-third of ED patients (30.8%, 95% CI 22.7 to 38.8%), 50.3% (95% CI 37.7 to 63.0%) of inpatients, and 23.5% (95% CI 14.4 to 32.7) of patients discharged from the ED were treated with corticosteroids. The most common investigation obtained was a chest x-ray (60.2% of all children; 95% CI 51.9 to 68.5%).


Infants with bronchiolitis receive medications and investigations for which there is little evidence of benefit. This suggests a need for knowledge translation strategies directed to community hospitals.

RÉSUMÉ Objectif

La bronchiolite est le principal motif d’hospitalisation des enfants en bas âge, mais peu d’études ont porté sur la prise en charge de la maladie, dans les hôpitaux communautaires. Les auteurs de l’étude ont donc examiné la prise en charge de la maladie chez les enfants traités dans les hôpitaux communautaires, en Ontario.


Les auteurs ont procédé à un examen rétrospectif d’une cohorte d’enfants consécutifs, âgés de moins de 12 mois, qui souffraient d’une bronchiolite et qui ont été traités dans 28 hôpitaux communautaires en Ontario, sur une période de 2 ans. La bronchiolite a été définie comme un premier épisode de respiration sifflante, associé à des signes d’une infection des voies respiratoires supérieures durant la période du virus respiratoire syncytial.


Sur 543 enfants admissibles à l’étude, 161 (29,7%; intervalle de confiance [IC] à 95% : 22,3 à 37,0%) ont été hospitalisés. Les taux d’admission à l’hôpital variaient énormément (intervalle interquartile : 0-40,3%). L’utilisation des bronchodilatateurs était courante au service des urgences (SU) (79,7% des patients; IC à 95% : 75,0 à 84,5%) ainsi qu’à l’étage (94,4% des patients; IC à 95% : 90,2 à 98,6%). Le salbutamol était le brochodilatateur le plus utilisé. Au moment du congé du SU, un brochodilatateur avait été prescrit à 44,7% (IC à 95% : 37,5 à 51,9%) des patients. Environ un tiers des patients traités au SU (30,8%; IC à 95% : 22,7 à 38,8%); 50,3% (IC à 95% : 37,7 à 63,0%) des enfants hospitalisés et 23,5% (IC à 95% : 14,4 à 32,7) des patients ayant obtenu leur congé du SU étaient traités par les corticostéroïdes. L’examen demandé le plus souvent était la radiographie des poumons (60,2% de tous les enfants; IC à 95% : 51,9 à 68,5%).


Les enfants en bas âge souffrant d’une bronchiolite reçoivent des médicaments et sont soumis à des examens pour lesquels il existe peu de données à l’appui de leurs avantages. Les résultats donnent à penser que des stratégies d’application des connaissances devraient être conçues à l’intention des hôpitaux communautaires.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Management of Bronchiolitis in Community Hospitals in Ontario: a Multicentre Cohort Study
      Available formats
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Management of Bronchiolitis in Community Hospitals in Ontario: a Multicentre Cohort Study
      Available formats
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Management of Bronchiolitis in Community Hospitals in Ontario: a Multicentre Cohort Study
      Available formats
Corresponding author
Correspondence to: Amy C. Plint, Children’s Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON, K1H 8L1. Email:
Hide All
1. Njoo H, Pelletier L, Spika J. Infectious diseases. In Respiratory disease in Canada (eds. Canadian Institute for Health Information, Canadian Lung Association, Health Canada, and Statistics Canada). Ottawa: Canadian Institute for Health Information; 2001, 65-87.
2. Langley JM, LeBlanc JC, Smith B, et al. Increasing incidence of hospitalization for bronchiolitis among Canadian children, 1980-2000. J Infect Dis 2003;188(11):1764-1767.
3. Craig E, Jackson C, Han DY, et al. Monitoring the Health of New Zealand Children and Young People: Indicator Handbook. Auckland, New Zealand: Paediatric Society of New Zealand, New Zealand Child and Youth Epidemiology Service; 2007.
4. Shay DK, Holman RC, Newman RD, et al. Bronchiolitis-associated hospitalizations among US children, 1980-1996. JAMA 1999;282(15):1440-1446.
5. Mansbach JM, Pelletier AJ, Camargo CA. US outpatient office visits for bronchiolitis, 1993-2004. Ambul Pediatr 2007;7(4):304-307.
6. Mansbach JM, Emond JA, Camargo CA. Bronchiolitis in US emergency departments 1992 to 2000: epidemiology and practice variation. Pediatr Emerg Care 2005;21(4):242-247.
7. Vogel AM, Lennon DR, Harding JE, et al. Variations in bronchiolitis management between five New Zealand hospitals: can we do better? J Paediatr Child Health 2003;39(1):40-45.
8. Plint AC, Johnson DW, Wiebe N, et al. Practice variation among pediatric emergency departments in the treatment of bronchiolitis. Acad Emerg Med 2004;11(4):353-360.
9. Schuh S, Lalani A, Allen U, et al. Evaluation of the utility of radiography in acute bronchiolitis. J Pediatr 2007;150(4):429-433.
10. Todd J, Bertoch D, Dolan S. Use of a large national database for comparative evaluation of the effect of a bronchiolitis/viral pneumonia clinical care guideline on patient outcome and resource utilization. Arch Pediatr Adolesc Med 2002;156(11):1086-1090.
11. Perlstein PH, Kotagal UR, Bolling C, et al. Evaluation of an evidence-based guideline for bronchiolitis. Pediatrics 1999;104(6):1334-1341.
12. Adcock PM, Sanders CL, Marshall GS. Standardizing the care of bronchiolitis. Arch Pediatr Adolesc Med 1998;152(8):739-744.
13. Kotagal UR, Robbins JM, Kini NM, et al. Impact of a bronchiolitis guideline: a multisite demonstration project. Chest 2002;121:1789-1797.
14. Plint AC, Johnson DW, Patel H, et al. Epinephrine and dexamethasone in children with bronchiolitis. N Engl J Med 2009;360(20):2079-2089.
15. Swingler GH, Hussey GD, Zwarenstein M. Duration of illness in ambulatory children diagnosed with bronchiolitis. Arch Pediatr Adolesc Med 2000;154(10):997-1000.
16. Donner A, Klar N. Confidence interval construction for effect measures arising from cluster randomization trials. J Clin Epidemiol 1993;46(2):123-131.
17. Donner A. A review of inference procedures for the intraclass correlation coefficient in the one-way random effects model. Int Stat Rev 1986;54:67-82.
18. Law BJ, De Carvalho V. Respiratory syncytial virus infections in hospitalized Canadian children: regional differences in patient populations and management practices. The Pediatric Investigators Collaborative Network on Infections in Canada. Pediatr Infect Dis J 1993;12(8):659-663.
19. Kellner JD, Ohlsson A, Gadomski AM, et al. Bronchodilators for bronchiolitis. Cochrane Database Syst Rev 2000;2:CD001266.
20. Hartling L, Wiebe N, Russell K, et al. A meta-analysis of randomized controlled trials evaluating the efficacy of epinephrine for the treatment of acute viral bronchiolitis. Arch Pediatr Adolesc Med 2003;157(10):957-964.
21. American Academy of Pediatrics Subcommittee on Diagnosis and Management of Bronchiolitis. Diagnosis and management of bronchiolitis. Pediatrics 2006;118(4):1774-1793.
22. Hartling L, Fernandes RM, Bialy L, et al. Steroids and bronchodilators for acute bronchiolitis in the first two years of life: systematic review and meta-analysis. BMJ 2011;342:d1714.
23. Skjerven HO, Hunderi JO, Brügmann-Pieper SK, et al. Racemic adrenaline and inhalation strategies in acute bronchiolitis. N Engl J Med 2013;368(24):2286-2293.
24. Ralston SL, Lieberthal AS, Meissner HC, et al. Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis. Pediatrics 2014;134(5):e1474-e1502.
25. Friedman JN, Rieder MJ, Walton JM. Bronchiolitis: Recommendations for diagnosis, monitoring and management of children one to 24 months of age. Paediatr Child Health 2014;19(9):485-498.
26. Johnson DW, Adair C, Brant R, et al. Differences in admission rates of children with bronchiolitis by pediatric and general emergency departments. Pediatrics 2002;110(4):e49.
27. Ralston S, Garber M, Narang S, et al. Decreasing unnecessary utilization in acute bronchiolitis care: results from the value in inpatient pediatrics network. J Hosp Med 2013;8(1):25-30.
28. Garrison MM, Christakis DA, Harvey E, et al. Systemic corticosteroids in infant bronchiolitis: A meta-analysis. Pediatrics 2000;105(4):E44.
29. Patel H, Gouin S, Platt RW. Randomized, double-blind, placebo-controlled trial of oral albuterol in infants with mild-to-moderate acute viral bronchiolitis. J Pediatr 2003;142(5):509-514.
30. Gupta P, Aggarwal A, Gupta P, et al. Oral salbutamol for symptomatic relief in mild bronchiolitis a double blind randomized placebo controlled trial. Indian Pediatr 2008;45(7):547-553.
31. Everard ML, Bara A, Kurian M, et al. Anticholinergic drugs for wheeze in children under the age of two years. Cochrane Database Syst Rev 2002;1:CD001279.
32. Walker C, Danby S, Turner S. Impact of a bronchiolitis clinical care pathway on treatment and hospital stay. Eur J Pediatr 2012;171(5):827-832.
33. Christakis DA, Cowan CA, Garrison MM, et al. Variation in inpatient diagnostic testing and management of bronchiolitis. Pediatrics 2005;115(4):878-884.
34. Russell K, Wiebe N, Saenz A, et al. Glucocorticoids for croup. Cochrane Database Syst Rev 2004;1:CD001955.
35. Plotnick LH, Ducharme FM. Combined inhaled anticholinergics and beta2-agonists for initial treatment of acute asthma in children. Cochrane Database Syst Rev 2000:4: CD000060.
36. Mittal V, Hall M, Morse R, et al. Impact of inpatient bronchiolitis clinical practice guideline implementation on testing and treatment. J Pediatr 2014;165(3):570-6.e3.
37. Parikh K, Hall M, Teach SJ. Bronchiolitis management before and after the AAP guidelines. Pediatrics 2014;133(1):e1-e7.
38. Van Cleve WC, Christakis DA. Unnecessary care for bronchiolitis decreases with increasing inpatient prevalence of bronchiolitis. Pediatrics 2011;128(5):e1106-e1112.
39. Johnson LW, Robles J, Hudgins A, et al. Management of bronchiolitis in the emergency department: impact of evidence-based guidelines? Pediatrics 2013;131(Suppl 1):S103-S109.
40. Norwood A, Mansbach JM, Clark S, et al. Prospective multicenter study of bronchiolitis: predictors of an unscheduled visit after discharge from the emergency department. Acad Emerg Med 2010;17(4):376-382.
41. Lapillonne A, Regnault A, Gournay V, et al. Impact on parents of bronchiolitis hospitalization of full-term, preterm and congenital heart disease infants. BMC Pediatr 2012;12:171.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Canadian Journal of Emergency Medicine
  • ISSN: -
  • EISSN: 1481-8035
  • URL: /core/journals/canadian-journal-of-emergency-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 54
Total number of PDF views: 329 *
Loading metrics...

Abstract views

Total abstract views: 2630 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 21st February 2018. This data will be updated every 24 hours.