Bronchiolitis Clinical Pathway – Emergency Department and Inpatient – Definition

Bronchiolitis Clinical Pathway – Emergency Department and Inpatient – Definition

Infant with Bronchiolitis

Definition

This pathway should be used for healthy infants 1 mo to 1 yr of age admitted with a clinical presentation consistent with the diagnosis of bronchiolitis. Older children up to 2 yrs of age may present with typical bronchiolitis, but this population may overlap with asthma and may require an individualized approach. Infants < 1 mo uncommonly present with lower respiratory viral infection, are at higher risk for apnea, and have typically been excluded from evidence referenced in this pathway.

A typical presentation of bronchiolitis: Symptoms of a viral URI (rhinorrhea, congestion, cough) in an infant progressing to lower respiratory involvement evidenced by a constellation of these findings:

Viral URI and cough, with signs of lower respiratory tract infection
  • Work of breathing
  • Tachypnea
  • Wheeze
  • Coarse rales
  • Fever is a common finding in bronchiolitis but other pathways may be considered based on other risk factors:

Findings suggesting another diagnosis include:

  • No upper respiratory symptoms (rhinorrhea, nasal congestion). Consider cardiac, pneumonia, foreign body.
  • Possible asthma:
    • Recurrent wheezing / prior bronchodilator or corticosteroid use
    • Age > 12 mos
    • Strong response to albuterol
      Consider Inpatient Asthma Pathway
  • Possible Pneumonia:
  • Pertussis: consider if:
    • Paroxysmal coughing spells, prolonged cough, or apnea
    • Known pertussis exposure

Exclusion Criteria (at high risk for severe bronchiolitis, may require additional diagnostic or treatment interventions):

  • Cardiac disease
  • Airway defects
  • Immunodeficiency
  • Significant lung disease (on baseline meds or O2)
  • Complex, chronic medical condition