[Acute viral bronchiolitis: a national study in pediatric emergency departments].
The 2000 French guidelines for acute viral bronchiolitis management underlined clinical criteria for hospitalization. We aimed to assess the impact of these guidelines on admission rates in pediatric emergency departments.


METHODS
A prospective multicentric observational study was conducted over 24h in 66 pediatric emergency departments. Questions were asked about the structure, the course of care, clinical data, resource utilization, and hospitalization or discharge of every patient under 2 years of age with acute viral bronchiolitis. An open-ended question allowed clinicians to explain the reason for hospitalization. Multivariable logistic regression analyses were performed to identify independent risk factors for severe disease to assess potential clinical factors associated with hospitalization. Responses were compared using the Student t-test and the Chi(2) test.


RESULTS
Of 338 patients enrolled, 145 (45.1%) were admitted. Clinical criteria were associated with hospitalization: clinical deterioration (OR: 3 [95% CI: 1.0-8.5], p=0.04), respiratory rate more than 60/min (OR: 3.4 [95% CI: 1.3-8.8], p=0.02), age under 6 weeks (OR: 29.8 [95% CI: 7.0-125.4], p<0.001), oxygen saturation less than 94% (OR: 15.8 [95% CI: 4.2-60.1], p<0.001), food intake less than 50% of the usual intake (OR: 4.9 [95% CI: 2.2-10.9], p<0.001), and age between 6 weeks and 3 months (OR: 3.2 [95% CI: 1.4-7.2], p=0.007).


CONCLUSIONS
The clinical criteria of the 2000 French guidelines influence hospitalization for acute viral bronchiolitis in pediatric emergency departments. However, other criteria are cited in about one-third of the patients.
Service de spécialités pédiatriques et médecine infantile, CHU Timone Enfants, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France.
S
S
Pailhous
Urgences pédiatriques, CHU Timone Enfants, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France.
V
V
Bresson
Laboratoire de santé publique, faculté de médecine, 27, boulevard Jean-Moulin, 13385 Marseille cedex 5, France.
A
A
Loundou
Réanimation et urgences pédiatriques, hôpital Mère-Enfant, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes, France.
C
C
Gras-Le-Guen
Service de pédiatrie, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France.
C
C
Marguet
Service de spécialités pédiatriques et médecine infantile, CHU Timone Enfants, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France.
B
B
Chabrol
Service de spécialités pédiatriques et médecine infantile, CHU Timone Enfants, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France. Electronic address: jean-christophe.dubus@ap-hm.fr.
J-C
JC
Dubus
D000208:Acute Disease; D001988:Bronchiolitis / Q000628:therapy* / Q000821:virology*; D004636:Emergency Service, Hospital; D005602:France; D006760:Hospitalization; D006801:Humans; D007223:Infant; D017410:Practice Guidelines as Topic; D011446:Prospective Studies