SCCM Resource Library-Epidemiology and Outcome Trends of Hospitalized Infants With RSV Bronchiolitis During 1997-2016

Video Transcription

Epidemiology and outcome trends of hospitalized infants with RSV bronchiolitis from 1997 to 2016. RSV is the most common cause of bronchiolitis in infancy.  Although most infections run a mild course, a significant number of patients require hospitalization and some form of respiratory support.  The aims of our study were to describe RSV epidemiology from 1997 to 2016, to examine trends in the prevalence of RSV, to analyze the presence  of complex chronic condition with RSV, to define the use of invasive mechanical ventilation in RSV infection, and to describe the mortality rate in the RSV and RSV  with complex chronic condition group. For methods, we perform a retrospective analysis of the kid's inpatient database from 1997 to 2016.  Neonates were excluded, and infants were defined as 29 days to 1 year of age. RSV infection in infants were identified using appropriate ICD-9 and 10 codes.  Demographics and outcome data were compared between infants with and without RSV, and trend analysis were performed using a stat calc. For results, a total of 416,723 out of more  than 7 million hospital discharges during infancy represented RSV bronchiolitis. Infants with RSV bronchiolitis were predominantly male, white,  and 3.8% had an associated complex chronic condition. Most of the children were discharged during the winter months and the minority during the summer months.  The use of invasive mechanical ventilation ranged from 2.5 in 1997 and went up to 5% in 2016. Associated complex chronic conditions were present in 3.7% of patients in 1997  and went up to 7.5 in 2016. The mortality rate in all RSV infants dropped from 0.12% in 1997 to 0.06% in 2012.  The following graphics depict the trend behavior for prevalence, invasive mechanical ventilation requirement, and mortality throughout the study timeframe, and compares both groups.  For both groups, you can notice an increase in prevalence. In the complex chronic condition group, there was a significant increase in the use  of invasive mechanical ventilation, and as for mortality, there was a significant drop in numbers in the complex chronic condition group.  Of note, there was a change in the diagnostic coding system from ICD-9 to ICD-10 in the study timeframe.  Invasive mechanical ventilation was used in only 3.2% of healthy infants, compared to 20.1% in those with complex chronic conditions.  The mortality rate was significantly higher when complex chronic conditions were present, and the use of invasive mechanical ventilation increased,  while the mortality decreased in the complex chronic condition group.  In conclusion, this large national trend analysis of hospitalized infants in the United States shows an increase in the prevalence and increase in the presence  of complex chronic conditions, and increase in the use of invasive mechanical ventilation from 1997 to 2016 in patients with RSV.  Also, we noticed a decrease in the hospital mortality rate during the same study timeframe. We suspect there might be factors beyond the scope of this study  that may also have affected this trend.  Thank you for your attention.

Video Summary

A study examined the epidemiology and outcomes of hospitalized infants with RSV bronchiolitis from 1997 to 2016. RSV is the most common cause of bronchiolitis in infants, with some requiring hospitalization and respiratory support. The study found an increase in the prevalence of RSV, the presence of complex chronic conditions, and the use of invasive mechanical ventilation from 1997 to 2016. However, the mortality rate decreased during the same period. Factors beyond the study's scope may have affected these trends.

Asset Subtitle

Pediatrics, Worldwide Data, 2022

Asset Caption

INTRODUCTION: Respiratory syncytial virus (RSV) is the most common viral infection in infants. The aims of this study were to describe the epidemiology and to analyze the trends in prevalence, the presence of complex chronic condition (CCC), and use of invasive mechanical ventilation (IMV), and mortality rate in infants that required hospitalization for RSV infection during 1997 to 2016.
METHODS: A retrospective analysis of the Healthcare Cost and Utilization Project’s Kids’ inpatient Database from 1997 to 2016 was performed. RSV infection in the age group 29 days to 1 year was identified with the use of appropriate ICD 9 and 10 codes. Demographic and outcome data were compared between infants with and without RSV infection (SPSS, IBM). Trend analyses were performed using StatCalc (Epi Info, CDC).
RESULTS: A total of 416,723 (5.5%) of 7,544,391 hospital discharges during infancy represented RSV bronchiolitis. Infants with RSV bronchiolitis were predominantly male (58%), white (47.5%) and 3.8% had an associated CCC. Most children were discharged during Jan-Mar (62%) and least during July-Sept (2.2%). RSV bronchiolitis discharges were relatively more frequent in the midwest and west compared to other discharges (p < 0.05). The use of IMV ranged from 2.5% in 1997 to 5% in 2016 (p < 0.001). Associated CCC was present in 3.7% in 1997 and increased to 7.5% in 2016 (p < 0.001). The mortality rate in all RSV infants decreased from 0.12% in 1997 and to 0.06% in 2012 (p < 0.05). IMV was used in 3.2% of infants with RSV bronchiolitis compared to 20.1% of those with CCC (OR:9.8, 95%CI:9.4-10.2; p < 0.001). The mortality rate for RSV bronchiolitis was significantly higher with the presence of CCC (1.57% vs 0.03%; OR 51.4, 95%CI: 41.4-63.8; p < 0.001). The use of IMV increased and the mortality rate decreased in infants with RSV and CCC during the study period (p < 0.05).
CONCLUSION:This large national cohort study shows that the prevalence of RSV bronchiolitis, the presence of CCC and the use of IMV increased from 1997 to 2016 in infants hospitalized with RSV bronchiolitis while mortality decreased. The presence of CCC is associated with increased use of IMV and mortality. There are seasonal and regional variation in hospitalization rates for infants with bronchiolitis.

Meta Tag

Content Type Presentation

Knowledge Area Pediatrics

Knowledge Area Worldwide Data

Knowledge Level Intermediate

Knowledge Level Advanced

Membership Level Select

Tag Respiratory Syncytial Virus RSV

Tag Epidemiology Outcomes

Tag Airway Management

Tag Mortality

Year 2022

Keywords

epidemiology

outcomes

RSV bronchiolitis

prevalence

mortality rate

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