title: Pediatricians' attitudes and costs of bronchiolitis in the emergency department: a prospective multicentre study.
abstract: BACKGROUND
  How pediatricians manage bronchiolitis and the derived total costs (direct and indirect) in the emergency department (ED) have not been fully characterized. The aim of the present study is to calculate those costs in a European country.
  
  
  METHODS
  A prospective and observational study, including 10 EDs of tertiary hospitals throughout Spain and during the bronchiolitis season 2010-2011, was performed. Every ED recruited children on random days of the week (3 days per week; always including one non-working day per every week). Recruitment aimed at a total sample size of 600 children. Direct (diagnostic procedures, time spent in the ED and medication) and indirect costs (work hours lost by parents, babysitting, travels, and meals) were collected. Comparisons between bronchiolitis caused by respiratory syncytial virus (RSV) and non-RSV bronchiolitis, as well as costs across severity categories were performed with the Kruskal-Wallis test. A multiple regression model was built to assess the influence of several of the studied factors on the total costs, including a RSV positive test and episode severity as independent variables; and gender, age, attending nursery school, preterm birth, low birth weight, smoker mother during pregnancy, and current smoker father as covariates.
  
  
  RESULTS
  From the 664 recruited children, direct mean costs were €213.2 ± 91.8 and indirect ones were €35.9 ± 55.3; the total costs being €249.2 ± 122.9. Costs were significantly higher in children positive to RSV and rose with increased severity. Those associations were maintained in the multiple regression analysis.
  
  
  CONCLUSIONS
  Although relatively low at the individual level (€249.2, mean total cost) the costs for just the ED expenses of bronchiolitis in Spain would add up to about €20 million per year.
authors.affiliation: Pediatric Respiratory and Allergy Unit, "Virgen de la Arrixaca" University Children's Hospital, University of Murcia, Murcia, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Garcia-Marcos
authors.forename: José
authors.initials: J
authors.lastname: Valverde-Molina
authors.forename: Svetlana
authors.initials: S
authors.lastname: Pavlovic-Nesic
authors.forename: Gemma
authors.initials: G
authors.lastname: Claret-Teruel
authors.forename: Ana C
authors.initials: AC
authors.lastname: Peñalba-Citores
authors.forename: Daniel
authors.initials: D
authors.lastname: Nehme-Álvarez
authors.forename: Javier
authors.initials: J
authors.lastname: Korta-Murua
authors.forename: Jesus
authors.initials: J
authors.lastname: Sánchez-Etxaniz
authors.forename: Maria T
authors.initials: MT
authors.lastname: Alonso-Salas
authors.forename: Carmen
authors.initials: C
authors.lastname: Campos-Calleja
authors.forename: Andrés
authors.initials: A
authors.lastname: Fernández-Villar
authors.forename: Julian
authors.initials: J
authors.lastname: Rodríguez-Suarez
mesh_terms: D000041:Absenteeism; D001291:Attitude of Health Personnel; D001988:Bronchiolitis / Q000191:economics* / Q000453:epidemiology; D003955:Diagnostic Tests, Routine / Q000191:economics; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D062407:Meals; D010372:Pediatrics; D011446:Prospective Studies; D018357:Respiratory Syncytial Virus Infections / Q000191:economics / Q000453:epidemiology; D012720:Severity of Illness Index; D013030:Spain / Q000453:epidemiology; D014195:Travel / Q000191:economics
keywords: bronchiolitis; costs; emergency department; syncytial respiratory virus; wheezing