Epidemiology and Seasonal Variation of stateHospital Admissions for Bronchiolitis among children in Malta

Malta medical journal

Frank Christian Casha¹  Rebecca Pisani¹  Justine Farrugia Preca¹ 

关键词: bronchiolitis;    Malta;    respiratory;    epidemiology;    seasonality;   

DOI  :  

学科分类：医学（综合）

来源: University of Malta * Medical School

【 摘 要 】

Bronchiolitis is a seasonal viral illness characterised by breathing difficulties, cough, poor feeding, irritability and lethargy and, in the very young, apnoea.1 General Practitioners (GPs) often encounter children with bronchiolitis and as GPs working in Malta, we noticed certain patterns of infection, such as the young age of this patient group, the increased frequency of occurrence in the winter months and a commonly reported history of Neonatal Intensive Care admission. We therefore looked for published local literature to determine the local epidemiology of this illness and found none. Review of the international literature led to an understanding of the existence of a specific seasonality of bronchiolitis in the northern hemisphere, with more admissions being recorded in the winter months.2–7 Particular trends in the demographics of admitted children were noted in the literature, specifically with younger patients, as well as children with previous Neonatal and Paediatric Intensive Care admission being more frequently admitted.3–5 This retrospective study was undertaken in order to establish whether there is any seasonal variation in the rate of hospitalization for bronchiolitis, what observations could be made about epidemiological factors describing these admissions and their radiographic and microbiological investigation in secondary care. Aim and intended learning outcomes: The aim of this retrospective study was to determine the local seasonality of hospital admission for bronchiolitis. Once determined, the results should aid physicians with diagnosis, referral and appropriate admission, and may guide promotion of vaccines that decrease the burden of vaccine preventable disease. Method: Records of hospital admissions for bronchiolitis among infants or children under two years of age at Mater Dei Hospital in Malta for the four year period covering January 2008 to December 2011 were examined, due to availability of data. Admission data, mainly name and patient identification number, together with basic demographics like locality of residence and dates of admission were collected from the Department of Health Information and Research and was used to identify the recorded cases after obtaining necessary permits from the Head of the Paediatric department at that time and also from the University of Malta Ethics Board. The diagnosis leading to the classification of the admission as one for bronchiolitis was validated by examining a significant sample of the doctors’ notes in the relevant patients’ files and matching these against clinical criteria for diagnosis.1 The number of admissions due to bronchiolitis per day was recorded. Each day, with its corresponding number of admissions was put accordingly into one of four groups as shown– Group 1 all days in December, January and February; Group 2 all days in March, April and May; Group 3 all days in June, July and August; Group 4 all days in September, October and November. These were then ranked, and a non-parametric test of significance, the Kruskal-Wallis equality-of-populations rank test, was used to determine whether there was any significant difference between the groups. Results: Our findings show a peak in admissions during the winter months. The median age of admission among children under two years of age was of 16 weeks; 10% had a past history of NPICU admission. 54.4% had a chest X-ray done and 41.6% were tested for causative organisms with a throat swab. Of the 41.6% tested, 19.4% tested positive for the Respiratory Syncitial Virus. The other results of these clinical tests are also described. Conclusions: In Malta, there is a higher number of hospital admissions for bronchiolitis among infants or children under two years during the winter months. The median age for admission is 16 weeks. Further studies are suggested to establish whether previous Neonatal and Paediatric Intensive Care Unit admission is a risk factor for bronchiolitis in Malta, and appropriately designed prospective studies are suggested to further assess the occurrence of causative organisms. We also suggest that national guidelines be drawn up for use in primary care for the appropriate identification and referral of cases of bronchiolitis, which peaks in the winter months.

【 授权许可】

Unknown