Bronchiolitis often starts with mild upper airway symptoms that then become severe. Bronchiolitis is typically believed to peak around 3-5 days before resolution occurs within a week or so. This belief about the peak of illness can drive medical decisions. But does day of onset of illness or the day when medical attention is sought influence the duration of a bronchiolitis hospitalization? Schroeder et al (10.1542/peds.2020-1537) evaluated whether a later day in the course of the illness for initial admission shortened the hospital stay and if an earlier day in the natural history of bronchiolitis lengthened the stay. The authors look at data from two multicenter prospective studies involving 746 children less than 2 years hospitalized with bronchiolitis. The main outcome measures were length of stay, receipt of positive-pressure ventilation, and total cough duration.
The authors discovered that the median initial day of admission in the course of bronchiolitis was day 4 (range 2-5 days). The authors also found that the day of illness at the time of admission had no association with the length of stay even when you control for relevant confounders. There were no differences noted either in day of illness relative to receiving positive-pressure ventilation or cough duration, nor were there differences in day of illness on first admission with those who were readmitted. Thus, when a parent asks how long will my child with bronchiolitis need to stay in the hospital, this study does some myth-busting in demonstrating that where a child may be in the time course of their illness will not necessarily predict length of stay. Check out this study and discussion by the authors of their findings and think about whether or not the care patients with bronchiolitis receive might be different depending on where they are in the course of their illness. If we could shorten length of stay for someone later in their illness, that might make us and a family of a child with bronchiolitis breathe more easily.