麻豆传媒

The cost of hospitalization for bronchiolitis among infants increased significantly in the past decade despite a lack of greater illness, reflecting changing coding practices and a growing tendency to send young kids to the intensive care unit (ICU), researchers reported.

From 2010 to 2019, the median standardized unit cost per bronchiolitis hospitalization among kids 2 years or younger rose from $5,636 to $6,973. At the same time, the proportion treated in the ICU more than doubled, growing from 12.4% to 25.9%, Robert Willer, DO, of the University of Utah in Salt Lake City, and colleagues reported.

For children without a complex chronic condition who did not need mechanical ventilation, costs for non-ICU care were stable during the study period, suggesting that the increasing costs were associated with higher ICU use, the authors wrote in .

Changes in coding practices saw the proportion of kids assigned an All Patient Refined Diagnosis Related Group for respiratory failure jump from 1.2% in 2010 to 21.6% in 2019 (P<0.001).

Yet throughout the changes in cost and coding, there was no evidence of worsening bronchiolitis severity. Median length of ICU stay decreased by 0.7 days during the study period, pointing to a lower threshold for ICU use, according to the researchers.

Willer's group suggested that the increase in resource use may be related to the widespread adoption of high-flow nasal cannula (HFNC) -- according to one estimate -- as ward-based HFNC protocols have been associated with increased ICU use.

Yet Christopher Horvat, MD, MHA, and Jonathan Pelletier, MD, both of the University of Pittsburgh, seemed to disagree.

"Many children admitted to the hospital with bronchiolitis will meet [objective criteria for respiratory failure], irrespective of a need for HFNC therapy, suggesting that the coding practices may be improving over time to achieve more appropriate reimbursements," they argued in a .

"There has never been evidence that HFNC therapy reduced the duration of bronchiolitis; it is considered a supportive treatment," the pair noted.

Bronchiolitis is primarily caused by respiratory syncytial virus (RSV) infection in young children. Annually, and half a million emergency department visits in children under the age of 5. This summer, RSV cases in children spiked in the U.S., , after a season of historically low cases of RSV, influenza, and other respiratory viruses.

The present study relied on the Pediatric Health Information Systems (PHIS) database for records on 385,883 bronchiolitis hospitalizations from 39 hospitals. Only children 24 months or younger were included (mean age 7.7 months). Boys comprised 58.9% of the cohort, and about two-thirds of the children were publicly insured. Patients with a length of stay longer than 30 days were excluded.

A major limitation of the study was its use of an administrative dataset lacking detailed clinical information such as HFNC use, Willer's team acknowledged.

The standardized unit cost in the PHIS database also doesn't necessarily reflect healthcare spending, the authors said.

"Declaring a causal relationship between increasing costs and admission to the ICU would require directly attributing an increase in ICUs to the desire to admit children with bronchiolitis to this care setting," Horvat and Pelletier wrote.

The editorialists noted that as of 2016, the number of pediatric ICU beds has been than the overall pediatric population.

"What is less clear is whether this expansion of ICU beds occurred, at least in part, to accommodate children with bronchiolitis or whether, instead, children with bronchiolitis are being cared for in ICUs that expanded for other reasons," Horvat and Pelletier said.

According to the duo, "given that most children do well with bronchiolitis in the developed world, the real challenges facing practicing pediatricians are how to most efficiently minimize transient discomfort associated with respiratory distress while also recognizing and rescuing the edge cases of bronchiolitis that could be lethal without the use of intensive treatment."

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