Materiały źródłowe

• #1 Bronchiolitis: Recommendations for diagnosis, monitoring and management of children one to 24 months of age

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4235450/

  Bronchiolitis is the most common reason for admission to hospital in the first year of life. The diagnosis of bronchiolitis is based primarily on the history of illness and physical examination findings. Laboratory investigations are generally unhelpful. […] Bronchiolitis is a clinical diagnosis based on a directed history and physical examination. Bronchiolitis may present with a wide range of symptoms and severity, from a mild upper respiratory tract infection (URTI) to impending respiratory failure. […] Diagnostic studies are not indicated for most children with bronchiolitis. Tests are often unhelpful and can lead to unnecessary admissions, further testing and ineffective therapies. Evidence-based reviews have not supported the use of diagnostic testing in typical cases of bronchiolitis.

• #1 Bronchiolitis: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/961963-overview

  Bronchiolitis is an acute inflammatory injury of the bronchioles that is usually caused by a viral infection (most commonly respiratory syncytial virus). […] The diagnosis of bronchiolitis is based on clinical presentation, the patients age, seasonal occurrence, and findings from the physical examination, which may reveal the following: Tachypnea, Tachycardia, Fever (38-39C), Retractions, Fine rales (47%); diffuse, fine wheezing, Hypoxia, Otitis media. […] When the clinical presentation, patients age, seasonal occurrence, and findings from the physical examination are consistent with the expected diagnosis of bronchiolitis, few laboratory studies are necessary. […] Diagnostic testing is controversial but is typically used to exclude other diagnoses (eg, bacterial pneumonia, sepsis, or congestive heart failure) or to confirm a viral etiology and determine required infection control for patients admitted to the hospital.

• #1 Diagnosis of premature bronchiolitis | Hospital Clínic Barcelona

  https://www.clinicbarcelona.org/en/assistance/diseases/premature-bronchiolitis/diagnosis

  Diagnosis is primarily clinical, based on symptoms. It also involves asking the baby’s parents questions, and a physical examination. […] The illness usually starts as catarrh in the upper respiratory tract (nose, mouth, throat), which may worsen over the course of 2 to 3 days. At first the baby presents sneezing, coughing, mucus and sometimes a fever. Over the following 2-3 days the coughing intensifies, symptoms of lower airway (bronchi and bronchioles) obstruction appear with laboured breathing, rapid breathing (tachypnoea) and irritability. […] Apnoea (pauses in breathing lasting a few seconds) can be a symptom of bronchiolitis, especially in young and premature infants, and is a significant risk factor for developing a severe case of bronchiolitis. […] When performing a pulmonary auscultation, the most common finding is expiratory wheezing (whistling sounds in the chest), although inspiratory crackles (sounds produced by air passing through liquid substances in the bronchi or alveoli) are also frequently heard. Wheezing can often be heard with the naked ear, without the aid of a stethoscope (audible wheezing).

• #1 Bronchiolitis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/bronchiolitis/diagnosis-treatment/drc-20351571

  Your child’s health care provider can usually diagnose bronchiolitis by the symptoms and listening to your child’s lungs with a stethoscope. […] Tests and X-rays are not usually needed to diagnose bronchiolitis. But your child’s provider may recommend tests if your child is at risk of severe bronchiolitis, if symptoms are getting worse or if the provider thinks there may be another problem. […] Tests may include: […] A chest X-ray can show if there are signs of pneumonia. […] A sample of mucus from your child’s nose can be used to test for the virus causing bronchiolitis. […] Occasionally, blood tests might be used to check your child’s white blood cell count. […] Your child’s provider may look for symptoms of dehydration, especially if your child has been refusing to drink or eat or has been vomiting.

• #1 Bronchiolitis: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/961963-overview

  Commonly used tests in the evaluation of patients with bronchiolitis include the following: Rapid viral antigen or nucleic acid amplification testing of nasopharyngeal secretions for respiratory syncytial virus, Arterial blood gas analysis, White blood cell count with differential, C-reactive protein level, Pulse oximetry, Blood cultures, Urine analysis, specific gravity, and culture, Cerebrospinal fluid analysis and culture, Serum chemistries. […] Chest radiographs are not routinely necessary. […] A practical approach is to obtain a chest radiograph in children who appear ill, are experiencing clinical deterioration, or are at high risk (eg, those with underlying cardiac or pulmonary disease). […] In rare situations (eg, severe immunodeficiency, strong history of possible foreign body aspiration), bronchoscopy may be indicated for diagnostic bronchoalveolar lavage or therapeutic foreign body removal.

• #1 Bronchiolitis – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/28

  Bronchiolitis is the leading cause of hospital admission in infants under 1 year of age. […] Respiratory syncytial virus (RSV) is the most common cause. […] Most cases are mild and self-limited, and supportive care is the only indicated therapy. […] Cough may persist for weeks, after 10 to 14 days of acute illness. Some patients may go on to develop recurrent wheeze. […] Viral bronchiolitis is an acute viral infection of the lower respiratory tract. […] The clinical manifestations include cough, wheeze, and labored breathing. […] Key diagnostic factors include cough, tachypnea, wheezing, retractions, grunting, and nasal flaring. […] Other diagnostic factors include rhinitis, fluctuating clinical findings, irritability, malaise, and poor feeding, fever 104F (40C), crackles, apnea, and thoracoabdominal asynchrony. […] 1st tests to order include pulse oximetry. […] Investigations to avoid include broad respiratory pathogen panels. […] Tests to consider include enzyme-linked immunosorbent assay (ELISA) rapid antigen detection, chest x-ray, and reverse transcriptase polymerase chain reaction (RT-PCR).

• #1 Bronchiolitis Workup: Approach Considerations, WBC Count and Differential, Sepsis Workup

  https://emedicine.medscape.com/article/961963-workup

  Although viral detection is commonly practiced and may have good utility, routine testing is not recommended in infants with bronchiolitis. […] Transcutaneous oxygen saturation is reduced in cases of moderate to severe bronchiolitis. […] Recent management guidelines have suggested lower limits of acceptable oxygen saturation levels of 90% for infants with bronchiolitis. […] Chest radiographs are not routinely necessary. […] Findings from chest radiography in individuals with bronchiolitis are variable. […] A practical approach is to obtain a chest radiograph in children who appear ill, are experiencing clinical deterioration, or are at high risk (eg, those with underlying cardiac or pulmonary disease).

• #1 Pediatric Bronchiolitis | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/26822

  Pediatric bronchiolitis is a lower respiratory tract infection primarily caused by viral pathogens. This condition is among the most common illnesses in children aged 2 or younger and the leading cause of hospitalization in this age group. […] Bronchiolitis is primarily a clinical diagnosis, but viral testing may be necessary in severe cases requiring hospitalization. Identifying the specific viral cause can support infection control measures and prevent nosocomial spread. […] In severe cases, infants with significant respiratory compromise may require mechanical ventilation. […] RSV is the leading infectious agent in acute bronchiolitis among children, accounting for up to two-thirds of cases. […] With the expansion of therapeutic options for respiratory infections, identifying the specific causative agent has become increasingly important. This is particularly vital in critically ill children, as determining the cause can guide targeted treatments and enhance outcomes.

• #1 Bronchiolitis Workup: Approach Considerations, WBC Count and Differential, Sepsis Workup

  https://emedicine.medscape.com/article/961963-workup

  According to a survey of hospital-based pediatricians, the most common tests are rapid viral antigen testing of nasopharyngeal secretions for respiratory syncytial virus (RSV), arterial blood gas (ABG) analysis (in severely ill patients, especially those requiring mechanical ventilation), white blood cell (WBC) count with differential, C-reactive protein (CRP) level, and chest radiography. […] Other common tests are pulse oximetry, blood culture, urine analysis and culture, and cerebrospinal fluid (CSF) analysis and culture. […] In previously healthy children with viral bronchiolitis, chest radiography, complete blood count (CBC), or blood culture are usually unnecessary. […] However, these tests should be carefully considered in persons with severe disease or a very ill appearance, preexisting cardiac or pulmonary disease, a markedly elevated temperature, or other risk factors for more severe disease.

• #1 Bronchiolitis Workup: Approach Considerations, WBC Count and Differential, Sepsis Workup

  https://emedicine.medscape.com/article/961963-workup

  The WBC count is usually 8,000-15,000/L and may be left-shifted as a result of stress. […] Although the WBC count with differential is commonly performed to look for coexisting bacterial infection, few studies have evaluated its utility for this purpose. […] Elevated WBC counts do not predict serious bacterial infection in children hospitalized with RSV bronchiolitis. […] In most patients with RSV bronchiolitis, especially those with mild disease, the risk of serious secondary bacterial infection is low. […] Multivariate analysis identifies temperature greater than 38C, oxygen saturation less than 92% at presentation, and a history of apnea as clinical predictors of the use of laboratory studies. […] When viral testing is performed, RSV is the most commonly isolated organism (26-95%).

• #1 Bronchiolitis

  https://www.rch.org.au/clinicalguide/guideline_index/Bronchiolitis/

  Bronchiolitis is a clinical diagnosis. Investigations are not indicated […] It is a clinical diagnosis, based on typical history and examination findings […] In most children with bronchiolitis, no investigations are required or recommended. Investigations should only be undertaken when there is deterioration or diagnostic uncertainty (eg cardiac murmur with signs of congestive cardiac failure) […] Chest X-ray (CXR) is not indicated and may lead to unnecessary treatment with antibiotics. CXRs cannot discriminate between viral and bacterial infections and are poorly reproducible in this age group […] Blood tests are not indicated (including blood gas, FBE, blood cultures) […] Virological testing (nasopharyngeal swab or aspirate) is not indicated in the management of individual children and should not be used to guide treatment.

• #1 Bronchiolitis Diagnosis and Treatment Still Difficult | MDedge

  https://community.the-hospitalist.org/content/bronchiolitis-diagnosis-and-treatment-still-difficult

  Indeed, evidence shows that ED physicians and radiologists may interpret chest X-rays very differently, often misdiagnosing bronchiolitis as bacterial pneumonia (J. Pediatr. 2007;150:429-33; Pediatr. Pulmonol. 2009;44:122-7). […] „Chest x-ray in a typical case of bronchiolitis leads to overdiagnosis of pneumonia and therefore overuse of antibiotics,” Dr. Robinson cautioned. […] „There is also need for better education for GPs and a better evidence base for management,” Dr. Thomas suggested. Primary care and general practitioners are uniquely placed to help monitor infants and young children, possibly preventing the need for emergency hospital admission.

• #1 Bronchiolitis – Core EM

  https://coreem.net/core/bronchiolitis/

  Viral upper respiratory prodrome followed by increased respiratory effort and wheezing in children less than 2 years of age. […] Clinical diagnosis. […] Rapid viral testing is of limited usefulness except for epidemiological surveillance, cohorting on inpatient wards to reduce nosocomial spread. […] Oxygen saturation and end-tidal CO2 monitoring in conjunction with respiratory rate, respiratory effort and mental status can be used to determine the presence of respiratory failure and the need for mechanical ventilation. […] Chest radiographs are not routinely recommended to diagnose bronchiolitis. […] Testing may be helpful in detecting co-infection with bacterial pathogens in febrile infants. […] Infants less than 60 days with fever should be evaluated for serious bacterial infection such as urinary tract infection.

• #1 Bronchiolitis differential diagnosis – wikidoc

  https://www.wikidoc.org/index.php/Bronchiolitis_differential_diagnosis

  Bronchiolitis must be differentiated from other respiratory and cardiac diseases that present with similar clinical manifestations of cough and dyspnea. Bronchiolitis should be differentiated from asthma, COPD, pneumonia, congestive heart failure, diffuse idiopathic neuroendocrine cell hyperplasia, tuberculosis, pertussis, foreign body aspiration, pulmonary embolism, and Harman-Rich syndrome. […] Bronchiolitis must be differentiated from other respiratory and cardiac diseases that can cause the similar clinical manifestations like cough and dyspnea. […] ELISA and immunoassays may be done in case of RSV infection. […] Pulmonary function test to exclude other lung diseases. […] CT scan shows: Intense bronchiolar mural inflammation, Bronchial wall thickening, Centrilobular nodules with tree-in-bud pattern.

• #1 Acute Bronchiolitis To Pediatric Inpatient Clinic In Patients Under 2 Years Old, Installed with Diagnosis Investigation of the Relationship of Bronchiolitis and Asthma – Gazi Medical Journal

  https://gazimedj.com/articles/acute-bronchiolitis-to-pediatric-inpatient-clinic-in-patients-under-2-years-old-installed-with-diagnosis-investigation-of-the-relationship-of-bronchiolitis-and-asthma/doi/gmj.2024.4060

  Previously considered a uniform disease, bronchiolitis has been revealed through research as heterogeneous, displaying varied phenotypes and clinical-histopathological differences among patients. […] Our study aimed to explore distinctions among children hospitalized with acute, severe bronchiolitis and identify potential asthma risk factors. […] Disease severity was assessed using the bronchiolitis severity score developed by the Turkish Thoracic Society. The asthma risk was evaluated using the modified Asthma Predictive Index (mAPI) designed for predicting future asthma in bronchiolitis cases. […] The majority of bronchiolitis cases were linked to asthma, with a significant 48.7% having a family history. This major risk factor implies a prevalent asthma phenotype. Moreover, 41% of patients with repeated hospitalizations and 64.1% API (+) reinforce this view. In summary, an early identification of patients at risk of asthma is crucial for tailoring appropriate treatment and safeguarding lung function.

• #1 Bronchiolitis: Recommendations for diagnosis, monitoring and management of children one to 24 months | Canadian Paediatric Society

  https://cps.ca/documents/position/bronchiolitis

  Bronchiolitis is a clinical diagnosis based on a directed history and physical examination. […] Diagnostic studies are not indicated for most children with bronchiolitis. […] The decision to admit should be based on clinical judgment and consider the infant’s respiratory status, ability to maintain adequate hydration, risk for progression to severe disease and the family’s ability to cope. […] The goals of this statement are to build on the comprehensive peer-reviewed AAP statement by incorporating new evidence, while providing the clinician with recommendations to help guide diagnosis, monitoring and management of previously healthy children one to 24 months of age who present with signs of bronchiolitis. […] Monitoring should include assessment and documentation of respiratory rate, work of breathing, oxygen saturation, findings on auscultation and general condition, including feeding and hydration status.

• #1

  https://journals.lww.com/aotm/fulltext/2018/13030/bronchiolitis_in_children__the_saudi_initiative_of.2.aspx

  Bronchiolitis is the leading cause of admissions in children less than two years of age. […] Usually, diagnosis of bronchiolitis is not challenging, however there has been historically no universally accepted and validated scoring system to assess the severity of the condition. […] Currently there is no effective curative treatment for bronchiolitis. […] Clinicians should diagnose bronchiolitis and assess severity based on history and physical examination, and should assess the risk factors. […] No single scoring system is used to assess the severity of bronchiolitis, nonetheless some suggestions for grading the severity of this disease is reported recently. […] The panel recommends routine use of pulse oximetry for clinical assessment decision-making regarding hospitalization and discharge.

• #1 Bronchiolitis – Clinical Practice Guideline | AAFP

  https://www.aafp.org/family-physician/patient-care/clinical-recommendations/all-clinical-recommendations/bronchiolitis.html

  The diagnosis of bronchiolitis and assessment of disease severity should be based on history and physical examination. Laboratory and radiologic studies should not be routinely ordered for diagnosis. […] Risk factors for severe disease such as age 12 weeks, premature birth, underlying cardiopulmonary disease, or immunodeficiency should be assessed when making decisions about evaluation and management of children with bronchiolitis. […] Bronchodilators (albuterol, salbutamol), epinephrine, and corticosteroids should not be administered to infants and children with the diagnosis of bronchiolitis. […] Nebulized hypertonic saline should not be administered to infants with the diagnosis of bronchiolitis in the emergency department. Nebulized hypertonic saline may be administered to infants and children hospitalized for bronchiolitis.

• #2 Bronchiolitis Workup: Approach Considerations, WBC Count and Differential, Sepsis Workup

  https://emedicine.medscape.com/article/961963-workup

  The diagnosis of bronchiolitis is based on clinical presentation, the patients age, seasonal occurrence, and findings from the physical examination. When all of these are consistent with the expected diagnosis of bronchiolitis, few laboratory studies are necessary. […] Tests are typically used to exclude other diagnoses (eg, bacterial pneumonia, sepsis, or congestive heart failure) or to confirm a viral etiology and determine required infection control for patients admitted to the hospital. Severely ill children may have dual viral infections. […] Although the use of diagnostic tests is common, several investigators argue that these should not be routinely performed, citing concerns about costs, inappropriate use of antibiotics, unnecessary hospitalization, and the lack of proven benefit.

• #2 Bronchiolitis: Recommendations for diagnosis, monitoring and management of children one to 24 months | Canadian Paediatric Society

  https://cps.ca/documents/position/bronchiolitis

  Bronchiolitis is a clinical diagnosis based on a directed history and physical examination. […] Diagnostic studies are not indicated for most children with bronchiolitis. […] The decision to admit should be based on clinical judgment and consider the infant’s respiratory status, ability to maintain adequate hydration, risk for progression to severe disease and the family’s ability to cope. […] The goals of this statement are to build on the comprehensive peer-reviewed AAP statement by incorporating new evidence, while providing the clinician with recommendations to help guide diagnosis, monitoring and management of previously healthy children one to 24 months of age who present with signs of bronchiolitis. […] Monitoring should include assessment and documentation of respiratory rate, work of breathing, oxygen saturation, findings on auscultation and general condition, including feeding and hydration status.

• #2 Bronchiolitis – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/28

  Bronchiolitis is the leading cause of hospital admission in infants under 1 year of age. […] Respiratory syncytial virus (RSV) is the most common cause. […] Most cases are mild and self-limited, and supportive care is the only indicated therapy. […] Cough may persist for weeks, after 10 to 14 days of acute illness. Some patients may go on to develop recurrent wheeze. […] Viral bronchiolitis is an acute viral infection of the lower respiratory tract. […] The clinical manifestations include cough, wheeze, and labored breathing. […] Key diagnostic factors include cough, tachypnea, wheezing, retractions, grunting, and nasal flaring. […] Other diagnostic factors include rhinitis, fluctuating clinical findings, irritability, malaise, and poor feeding, fever 104F (40C), crackles, apnea, and thoracoabdominal asynchrony. […] 1st tests to order include pulse oximetry. […] Investigations to avoid include broad respiratory pathogen panels. […] Tests to consider include enzyme-linked immunosorbent assay (ELISA) rapid antigen detection, chest x-ray, and reverse transcriptase polymerase chain reaction (RT-PCR).

• #2 Bronchiolitis Causes & Symptoms

  https://my.clevelandclinic.org/health/diseases/8272-bronchiolitis

  Your childs healthcare provider will diagnose bronchiolitis after a physical exam and testing. During the exam, your childs provider will check their vital signs and temperature and listen to their breathing through a stethoscope (auscultation). […] Testing might include a nasal fluid culture, which is a swab that collects fluid from the inside of your childs nose to detect viruses. If your child has severe symptoms, a chest X-ray might be necessary. […] Bronchiolitis has symptoms that are similar to other respiratory infections like bronchitis and pneumonia. It may seem like asthma, which can cause wheezing and trouble breathing. You might wonder if your child breathed in (aspirated) something other than air. […] Treatment for bronchiolitis focuses on symptom relief, including: Antipyretic (fever reducer) medications. Antiviral medications (like oseltamivir for the flu).

• #2 Bronchiolitis – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/bronchiolitis/

  Bronchiolitis is a clinical diagnosis based on the patient’s age and the presence of classic clinical features of bronchiolitis. […] Further testing is not usually required but may be considered in patients with: severe disease, e.g., if there is concern for respiratory failure; suspected complications of bronchiolitis; diagnostic uncertainty to rule out differential diagnoses of bronchiolitis. […] Blood gas indicated for worsening severe disease and/or impending respiratory failure may show hypoxemia and/or CO2 retention. […] Chest x-ray indications: severe disease if there is diagnostic uncertainty or suspected complications (e.g., pneumothorax, pneumonia). […] Bronchiolitis in infancy is associated with an increased risk of developing asthma.

• #2

  https://journals.lww.com/aotm/fulltext/2018/13030/bronchiolitis_in_children__the_saudi_initiative_of.2.aspx

  Bronchiolitis is the leading cause of admissions in children less than two years of age. […] Usually, diagnosis of bronchiolitis is not challenging, however there has been historically no universally accepted and validated scoring system to assess the severity of the condition. […] Currently there is no effective curative treatment for bronchiolitis. […] Clinicians should diagnose bronchiolitis and assess severity based on history and physical examination, and should assess the risk factors. […] No single scoring system is used to assess the severity of bronchiolitis, nonetheless some suggestions for grading the severity of this disease is reported recently. […] The panel recommends routine use of pulse oximetry for clinical assessment decision-making regarding hospitalization and discharge.

• #2 Bronchiolitis: Causes, Symptoms, and Treatment | Doctor

  https://patient.info/doctor/bronchiolitis-pro

  Bronchiolitis is a clinical diagnosis based upon typical symptoms and signs. […] The National Institute for Health and Care Excellence (NICE) guidelines state that bronchiolitis should be diagnosed in children under the age of 2 years who present with a 1- to 3-day history of coryzal symptoms, followed by persistent cough; and either tachypnoea or chest recession (or both); and either wheeze or crackles on chest auscultation (or both). […] Take a history, and examine the child, making note of capillary refill time, respiratory rate, heart rate, chest signs, etc. Following examination, measure oxygen saturation in any child with suspected bronchiolitis. […] NICE recommends admission for children with bronchiolitis assessed in a secondary care setting if they have any of the following: Apnoea (observed or reported); Persistent oxygen saturation (when breathing air) of less than 90%, for children aged 6 weeks and over; Inadequate oral fluid intake (50 to 75% of usual volume), taking account of risk factors and using clinical judgement; Persisting severe respiratory distress, eg, grunting, marked chest recession, or a respiratory rate of over 70 breaths/minute.

• #2 Bronchiolitis Workup: Approach Considerations, WBC Count and Differential, Sepsis Workup

  https://emedicine.medscape.com/article/961963-workup

  Although viral detection is commonly practiced and may have good utility, routine testing is not recommended in infants with bronchiolitis. […] Transcutaneous oxygen saturation is reduced in cases of moderate to severe bronchiolitis. […] Recent management guidelines have suggested lower limits of acceptable oxygen saturation levels of 90% for infants with bronchiolitis. […] Chest radiographs are not routinely necessary. […] Findings from chest radiography in individuals with bronchiolitis are variable. […] A practical approach is to obtain a chest radiograph in children who appear ill, are experiencing clinical deterioration, or are at high risk (eg, those with underlying cardiac or pulmonary disease).

• #2 Pediatric Bronchiolitis | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/26822

  Bronchiolitis is primarily diagnosed clinically. Diagnosis and assessment of illness severity should be based on a comprehensive history of the present illness and the patient’s clinical signs. […] Laboratory investigations for patients with bronchiolitis should include viral identification when possible. […] The management of bronchiolitis is primarily supportive, and it usually focuses on ensuring hydration, performing upper airway suctioning as needed, and monitoring for signs of respiratory failure or the need for intubation and mechanical ventilation. […] Viral testing should be considered for hospitalized infants, especially for isolation and infection control. […] The mainstay of treatment includes supportive care such as hydration, nasal suctioning, and oxygen therapy for hypoxemia. […] Routine use of glucocorticoids or antibiotics is not recommended. […] Antivirals, such as oseltamivir for influenza or nirmatrelvir-ritonavir for SARS-COV-2, may be used when indicated. […] Diagnosis is based on the patient’s history and physical examination.

• #2 Diagnostic Testing for RSV | RSV | CDC

  https://www.cdc.gov/rsv/hcp/clinical-overview/diagnostic-testing.html

  Several types of laboratory tests can confirm RSV infection. […] Nucleic acid amplification tests (NAATs), such as PCR tests, are highly sensitive and can be used to diagnose anyone with RSV. Antigen tests are also available. […] Several types of laboratory tests are available to confirm RSV infection. These tests may be performed on upper and lower respiratory specimens. […] The most commonly used types of RSV clinical laboratory tests are: Nucleic acid amplification tests (NAATs), such as real-time reverse transcription-polymerase chain reaction (rRT-PCR), are highly sensitive tests for virus detection. […] Antigen tests are generally less sensitive than NAATs but can provide quicker results. […] Both rRT-PCR and antigen detection tests are effective methods for diagnosing RSV. Healthcare providers should consult experienced laboratorians for more information on the type of respiratory specimen to be collected, interpretation of results, and expected performance of the specific test to be used.

• #2 Bronchiolitis Clinical Pathway | Connecticut Children’s

  https://www.connecticutchildrens.org/medical-professionals/clinical-pathways/bronchiolitis

  Quality Metrics: Percentage of patients without viral testing, excluding influenza COVID-19 (ED to discharge and ED to inpatient). […] Key References: Ralston SL, Lieberthal AS, Meissner HC, et al. Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis. Pediatrics. 2014 Nov;134(5):e1474-e502.

• #2 Bronchiolitis: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/961963-overview

  Commonly used tests in the evaluation of patients with bronchiolitis include the following: Rapid viral antigen or nucleic acid amplification testing of nasopharyngeal secretions for respiratory syncytial virus, Arterial blood gas analysis, White blood cell count with differential, C-reactive protein level, Pulse oximetry, Blood cultures, Urine analysis, specific gravity, and culture, Cerebrospinal fluid analysis and culture, Serum chemistries. […] Chest radiographs are not routinely necessary. […] A practical approach is to obtain a chest radiograph in children who appear ill, are experiencing clinical deterioration, or are at high risk (eg, those with underlying cardiac or pulmonary disease). […] In rare situations (eg, severe immunodeficiency, strong history of possible foreign body aspiration), bronchoscopy may be indicated for diagnostic bronchoalveolar lavage or therapeutic foreign body removal.

• #2 Bronchiolitis

  https://www.rch.org.au/clinicalguide/guideline_index/Bronchiolitis/

  Bronchiolitis is a clinical diagnosis. Investigations are not indicated […] It is a clinical diagnosis, based on typical history and examination findings […] In most children with bronchiolitis, no investigations are required or recommended. Investigations should only be undertaken when there is deterioration or diagnostic uncertainty (eg cardiac murmur with signs of congestive cardiac failure) […] Chest X-ray (CXR) is not indicated and may lead to unnecessary treatment with antibiotics. CXRs cannot discriminate between viral and bacterial infections and are poorly reproducible in this age group […] Blood tests are not indicated (including blood gas, FBE, blood cultures) […] Virological testing (nasopharyngeal swab or aspirate) is not indicated in the management of individual children and should not be used to guide treatment.

• #2 Bronchiolitis Workup: Approach Considerations, WBC Count and Differential, Sepsis Workup

  https://emedicine.medscape.com/article/961963-workup

  The WBC count is usually 8,000-15,000/L and may be left-shifted as a result of stress. […] Although the WBC count with differential is commonly performed to look for coexisting bacterial infection, few studies have evaluated its utility for this purpose. […] Elevated WBC counts do not predict serious bacterial infection in children hospitalized with RSV bronchiolitis. […] In most patients with RSV bronchiolitis, especially those with mild disease, the risk of serious secondary bacterial infection is low. […] Multivariate analysis identifies temperature greater than 38C, oxygen saturation less than 92% at presentation, and a history of apnea as clinical predictors of the use of laboratory studies. […] When viral testing is performed, RSV is the most commonly isolated organism (26-95%).

• #2 Bronchiolitis

  https://www.pediatriconcall.com/articles/infectious-diseases/bronchiolitis/bronchiolitis-introduction

  The diagnosis of acute bronchiolitis is clinical; an infant who presents with the above symptoms and physical examination in an epidemiological context doesnt need further tests to be diagnosed. […] Some tests might be advisable to assess the degree of severity, the presence of complications or to rule out an alternative diagnosis. […] Chest X-ray shows hyperinflated lungs with patchy atelectasis. It is not advisable to be routinely done when the patients present a clear diagnosis of bronchiolitis, as the findings could be misleading of bacterial pneumonia. However, it is recommended if the latter is suspected in the presence of high fever or focal crackles on auscultation. […] Routine full blood count or biochemistry is not recommended. The most frequent findings are normal or high lymphocyte count with normal C reactive protein. In the case of neutrophilia with high inflammatory markers, the bacterial infection should be suspected. […] The diagnosis of acute bronchiolitis is clinical; an infant who presents with the above symptoms and physical examination in an epidemiological context doesnt need further tests to be diagnosed.

• #2 Acute Bronchiolitis To Pediatric Inpatient Clinic In Patients Under 2 Years Old, Installed with Diagnosis Investigation of the Relationship of Bronchiolitis and Asthma – Gazi Medical Journal

  https://gazimedj.com/articles/acute-bronchiolitis-to-pediatric-inpatient-clinic-in-patients-under-2-years-old-installed-with-diagnosis-investigation-of-the-relationship-of-bronchiolitis-and-asthma/doi/gmj.2024.4060

  Recent studies have increasingly revealed both clinical and histopathological differences among patients. This evidence indicates that bronchiolitis is a heterogeneous disease with various phenotypes. Identifying the phenotypes associated with asthma is crucial for ensuring appropriate treatment and preventing future impairment of respiratory function and development of chronic persistent asthma. […] The aim of our study was to investigate differences among children hospitalized for the treatment of acute severe bronchiolitis to identify risk factors for asthma. […] According to the modified API, the probability of developing asthma after the age of 3 years in patients with API positivity is 90%. In our study, the prevalence of modified API positivity criteria was as high as 64%. The high rates of recurrent attacks and API positivity suggest that there is a significant number of children with asthma phenotypes in our study group.

• #2 Bronchiolitis: Update on Diagnosis and Management of Viral Bronchiolitis in ED | RECAPEM

  https://recapem.com/bronchiolitis-update-on-diagnosis-and-management-of-viral-bronchiolitis-in-ed/

  Chest radiographs are not necessary in the routine evaluation of bronchiolitis and they should be obtained only if there are clinical findings suggestive of other potential diagnoses. […] Findings in severely affected patients include work of breathing (subcostal, intercostal, and supraclavicular retractions; nasal flaring; and expiratory grunting), cyanosis, and poor peripheral perfusion. […] Features which help to identifying severity of illness and hospitalization should be sought including: assessment of hydration status (eg, fluid intake, urine output), symptoms of respiratory distress (tachypnea, nasal flaring, retractions, grunting), cyanosis, episodes of restlessness or lethargy (may indicate hypoxemia and/or impending respiratory failure), and a history of apnea with or without cyanosis or bradycardia. […] In children of any age with unusual or severe course extensive work up (e.g. CBC, cultures, urinalysis) may be warranted.

• #2 Bronchiolitis Clinical Pathway | Connecticut Children’s

  https://www.connecticutchildrens.org/medical-professionals/clinical-pathways/bronchiolitis

  Bronchiolitis, a viral infection of the lower respiratory tract that primarily affects infants ages 0-24 months, is the most frequent cause of hospital admission for children under 1 year of age, accounting for upwards of 18% of all hospitalizations in the United States. […] In 2014, the AAP published updated guidelines on the diagnostic work up, treatment, and prevention of bronchiolitis. […] Previously there had been variation in practice amongst providers, and little evidence to support certain commonly used modalities of diagnosis and treatment. […] The objectives of this pathway are to: Standardize delivery of evidence based care to infants with bronchiolitis. […] Avoid routine use of therapies and testing that have been shown to have little clinical benefit (i.e. routine viral testing, chest x-rays, antibiotic use, steroids, bronchodilators).

• #3 Bronchiolitis – Clinical Practice Guideline | AAFP

  https://www.aafp.org/family-physician/patient-care/clinical-recommendations/all-clinical-recommendations/bronchiolitis.html

  The diagnosis of bronchiolitis and assessment of disease severity should be based on history and physical examination. Laboratory and radiologic studies should not be routinely ordered for diagnosis. […] Risk factors for severe disease such as age 12 weeks, premature birth, underlying cardiopulmonary disease, or immunodeficiency should be assessed when making decisions about evaluation and management of children with bronchiolitis. […] Bronchodilators (albuterol, salbutamol), epinephrine, and corticosteroids should not be administered to infants and children with the diagnosis of bronchiolitis. […] Nebulized hypertonic saline should not be administered to infants with the diagnosis of bronchiolitis in the emergency department. Nebulized hypertonic saline may be administered to infants and children hospitalized for bronchiolitis.

• #3 Bronchiolitis in Infants and Toddlers (and differentiating this from Asthma) : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/bronchiolitis-in-infants-and-toddlers-and-differentiating-this-from-asthma/

  Bronchiolitis is a clinical diagnosis. No workup is advised. […] The vast majority of patients presenting with bronchiolitis will have mild/moderate disease severity. […] Children with risk factors for severe disease (immunodeficiency, history of premature birth <32 weeks GA, age <48 weeks post conception, underlying cardiopulmonary disease) or those who are very unwell (RR >70, oxygen saturation <90% on room air, marked work of breathing, lethargy) deserve investigation and a trial of treatment. [...] The best way to distinguish bronchiolitis from asthma in the ED, is probably by the response to a trial of salbutamol metered-dose inhaler. [...] If demonstrated improvement in oxygen saturation, work of breathing, the patient should be diagnosed with ASTHMA. [...] Antipyretics + nasal suction + oral/NG tube rehydration are often sufficient treatment. [...] Criteria For Hospital Admission: Oxygen saturation <90% awake or asleep. [...] Criteria For Transfer To Another Facility: Oxygen saturation <90% despite 2 L/kg/min of 100% oxygen via nasal cannula. [...] Investigation and treatment of bronchiolitis. [...] Bronchiolitis severity assessment.

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