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Chest auscultatory signs in infants presenting to A&E with bronchiolitis
Kirsty E McLellan1, Jürgen Schwarze, Tom Beattie
1aDepartment of Child Life and Health, University of Edinburgh bRoyal Hospital for Sick Children, Edinburgh, UK.
Insights
Bronchiolitis chest signs vary with infant age, not the specific virus. Younger infants (<4 months) often lack chest signs, while older infants (>6 months) are more prone to wheezing.
Area of Science:
- Pediatric Respiratory Medicine
- Infectious Diseases
Background:
- Clinical presentation of bronchiolitis in infants is variable.
- Traditional chest auscultation findings are inconsistently observed.
Purpose of the Study:
- To investigate the influence of infant age and causative pathogen on auscultatory chest signs in bronchiolitis.
- To formally assess the variability of clinical signs in infant bronchiolitis.
Main Methods:
- Prospective cohort study of infants (<12 months) with bronchiolitis.
- Recruitment from a pediatric Emergency Department.
- Analysis of auscultatory findings (crackles, wheeze, absence of signs) in relation to age and viral etiology.
Main Results:
- Infants presenting with wheeze were significantly older (26.6 weeks) than those without wheeze (17.3 weeks).
- Infants without chest signs were younger (15.1 weeks) than those with chest signs (24.4 weeks).
- No significant difference in chest signs was associated with the specific respiratory virus identified.
Conclusions:
- Age is a significant factor influencing the presentation of bronchiolitis chest signs.
- Younger infants (<4 months) are more likely to present without auscultatory chest signs.
- Older infants (>6 months) are more likely to exhibit wheezing as a presenting sign.
Background:
Anecdotally it has been noted that the traditional chest signs associated with bronchiolitis appear inconsistently in infants clinically diagnosed with bronchiolitis. We wished to explore this more formally.
Objective:
The aim of this study was to assess whether the auscultatory chest signs at presentation in infants with bronchiolitis were influenced by age or by the underlying pathogen.
Materials And Methods:
We conducted a prospective opportunistic cohort study, recruiting infants less than 12 months old who presented with bronchiolitis to the Emergency Department of the Royal Hospital for Sick Children in Edinburgh.
Results:
Eighty-six infants were recruited. Infants who presented with wheeze were significantly older [26.6 (±1.9) weeks] than those without wheeze [17.3 (±2.1) weeks] (analysis of variance, P=0.002). Those who presented without any chest signs on auscultation were younger than those with chest signs [15.1 (±2.6) weeks compared with 24.4 (±1.7) weeks] (analysis of variance, P=0.006). We did not detect any difference in any of the auscultatory chest signs (crackles, wheeze or absence of signs) depending on the virus responsible for bronchiolitis.
Conclusion:
Clinical signs associated with bronchiolitis vary according to age. Infants older than 6 months are more likely to present with wheeze and infants less than 4 months old are likely to present without chest signs on auscultation.
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