Clinical Characteristics and Outcome of Patients with Bronchiolitis in Community Emergency Department in Saudi Arabia
Dr Surriya Bibi Sajid *, Dr Adel Abdulla Altamimi, Dr Syed Amir Ahmad,
Omar Barayyan, Adel Abdulrahman Aljaffen
*Correspondence to: Dr Surriya Bibi Sajid.
Copyright
© 2026: Dr Surriya Bibi Sajid. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 06 July 2026
Published: 01 August 2026
DOI: https://doi.org/10.5281/zenodo.21714401
Abstract
Background: Bronchiolitis is a self-limiting disease of children caused by viral lower respiratory tract infection involving the smaller airways or bronchioles. Major causative agent is respiratory syncytial virus (RSV). Bronchiolitis has a wide spectrum of illness severity. Review of literature reveals need for identification of subgroup of patients with higher likelihood of hospital admission needing timely intervention to prevent a higher morbidity and mortality.
Aim: The aim of this study was to see characteristics, and to identify the outcome of patients in emergency department with bronchiolitis.
Setting: Retrospective chart review over 4-years period from January 2016 to December 2019.
Subjects: All children less than five years old, presented with a clinical diagnosis of bronchiolitis in emergency department during the study period were enrolled.
Materials and Methods: A retrospective chart review based on computer records of all emergency patients with clinical diagnosis of bronchiolitis over 4-years period was conducted.
Results: Majority of patients presenting with bronchiolitis were male (58%). Almost all (98.5%) presented at <2 years. only 3 cases presented after 2 years of age. Most of patients present between October and February. Commonest symptoms at the time of presentation was cough (98.5%), fever was found in (59%), running nose in (54%), respiratory distress in 53%. Poor oral intake in 12%, Vomiting in 7.2%, saturation <92% was found in (4%). One child present with apnoea,4.6% needed admission in ICU. Out of the total 206 patients with bronchiolitis 31% were admitted. 65% were discharged on home medicine. 50% of admitted patients required admission for >72hours.19% cases were referred to tertiary care unit, 4.69% needed intensive care unit 3% were intubated. Amongst 78 patients for whom nasopharyngeal swab done 65% came positive for viral isolation and out of positive swab 61% were positive for RSV and 4% for other viruses. Recurrent wheeze found in 31%.
Conclusion: Based on the result it can be concluded that bronchiolitis is a self-limiting disease. However just under 1/3rd of patient required hospital admission. Few 9.2% were having treatable complications. Majority were discharge on home treatment. 1/3rd of patient later on developed recurrent wheeze and labelled as asthma as observed from their computer records.
Key Words: Bronchiolitis, respiratory syncytial virus, ICU, apnoea, wheeze.
Introduction
Bronchiolitis is the most common acute lower respiratory tract infection in children less than 2 years of age. Bronchiolitis is a clinical diagnosis based on history and physical examination (1). American Academy of Paediatrics (AAP) together with the European Respiratory Society (ERS) defines bronchiolitis as a clinical constellation of clinical symptoms and signs including a viral respiratory prodromal followed by increase lower respiratory efforts and wheezing in infants (2). RSV is the causative agent in 70% of cases worldwide (3). The reported prevalence of RSV in the Kingdome of Saudi Arabia has wide variations 25-88% (4).
Peak incidence of RSV is 1-6 months of age. In northern hemisphere bronchiolitis season peaks in January. The natural immunity is of short duration thus repeated infections are common particularly in high risk group. In 30% cases other viral agents can be involved like Metapneumovirus, Rhinovirus, Parainfluenza virus, Boca virus, Adenovirus (5). RSV viral burden in Saudi Arabia is still high. One study conducted in King Khalid University Hospital showed 79% of children admitted with upper respiratory tract infections were RSV positive (6). Bronchiolitis and pneumonia resulting from RSV are more common in boys than in girls by a ratio of approximately 1.5:1 (7).
It affects 1-3% of all healthy children and more than 10% in high risk. 2-10% cases of bronchiolitis require hospital admission(8). 5% RSV positive bronchiolitis requires ICU care. The lower respiratory tract is involved to a varying degree with bronchiolitis and bronchopneumonia in about a third of children (9). The hospitalization rate for RSV infection in otherwise healthy infants is typically 0.5-4%, depending on region, gender, socioeconomic status, exposure to cigarette smoke, gestational age, and family history of atopy. Mortality is lower in developed countries as compare to under developed and developing countries. Mortality is also higher in high risk group (10). Many children with asthma have a history of bronchiolitis in infancy. There is recurrent wheezing in 30-50% of children with severe RSV bronchiolitis in infancy. The likelihood of recurrence is increased in the presence of an allergic diathesis (e.g., eczema, hay fever, or a family history of asthma) (11). The purpose of our study was to identify characteristics, need of admission and outcome of children visit to our emergency with diagnosis of bronchiolitis.
Material and Methods
This study is a retrospective study done during 4-years periods from January 2016 to December 2019. Study was conducted in King Adulaziz University Hospital emergency department which is having 4 bedded short stay unit where patients are admitted for short period 24-48 hours and if not improving in 48 hours or need treatment in tertiary care unit are transfer to King Khalid University hospital as per hospital policy.
Electronic Charts of all the children <5 years of age with clinical diagnosis of bronchiolitis were reviewed (patients having wheeze because of other aetiology were excluded from study). Charts were reviewed for documentation of presenting complaint, demographic profile, clinical findings and disposition including indications for admission, complications, referral to tertiary care unit, ICU admission, intubation and recurrent wheeze. The electronic file of patients was reviewed regarding the laboratory work up like complete blood count, nasopharyngeal swab and x-ray chest and further follow up in emergency department (data collected from computer record) with recurrent wheeze. The data was recorded on standard pro forma and on standard excel sheet. The results were plotted in the form of bar charts and pie chart along with data on tables.
Results
There were total of 206 patients identified for inclusion in the study. They included 119(58%) males and 87(42%) female as shown in Table 1. The distribution of presenting signs and symptoms in the patients is represented in Table 2. Almost all patients 99% had some degree of cough, Fever (59%), Shortness of breath (53%, Running nose (54%) were the other common presenting symptoms. Hypoxia with an oxygen saturation <92% was found in 8 (4%) patients. Among the admitted children majority was admitted because of respiratory distress poor feeding and vomiting.
Disposition of Patients is represented in pie chart below. while 64 (31%) patients required admission in hospital, 134 (65%) were discharged on home medicine and 8 (3.88%)were given referral for treatment in other hospitals according to hospital policy.
Recurrent wheeze was found in 65 (32%)cases. 7 (11%)showed Eosinophilia, majority 67.21% were having normal eosinophil count. Relationship between patient having eosinophilia and recurrent wheeze was seen. Out of 7case 4 were having high eosinophils counts and recurrent wheeze.
RSV screening was done for most of the admitted cases and few of those who were discharged on home medicine RSV screening done for 78 (38%) of total patient and out of these 53 were amongst those who were admitted (82%) of admitted patient.
Positive result for RSV was found in 48(61%) cases. 3 (4%) cases were positive for influenza. Negative swab was seen in 27(35%).
Outcome of admitted patients is shown in Table 7. 22 (34%) were discharged within 24 to 48 hours. 10 (16%) discharged from 48 to 72 hours and remaining 32(50%) patients needed prolonged admission over 72. only 1 patient left hospital against medical advice .12 (18.7%) patients were referred to our sister tertiary care unit and 3 (4.69 %) required care in ICU setting. 2(3%) patients needed intubation and ventilation.
Complications 0.49% present with apnoea, 2 patients (0.97%) developed respiratory failure. 19 cases (9.22%) cases were having pneumonia on x-ray.
Discussion
Bronchiolitis is the most common viral lower respiratory tract infection in childhood. It is a seasonal disease appearing most frequently as an epidemic during winter months as confirmed in our study (12). It is predominantly distributed in male also seen in our subject group. Most studies have reported a good long-term prognosis as in our study all patients were discharged from hospital. Although some cases present with apnoea but no long term or chronic complications was found (13). Bronchiolitis represents a large public health burden throughout the world where 2%–10% of cases require hospitalization. As against this a much higher percentage of 31% in our study needed admission to hospital (14).
A reported 5% of RSV bronchiolitis cases require Intensive Care Unit (ICU) admission which is similar to our study (4.6%) (15). Chest radiographs findings in hospitalized patient with RSV bronchiolitis ranged from normal in approximately 30% of cases, remaining showing variable findings including hyper expansion of lungs, peri-bronchial thickening, and interstitial infiltrates. Segmental or lobar consolidation is reportedly unusual but in our study it accounted 28% which is higher as compare to other studies (16,17). In our study RSV is the predominant organism responsible for around 61% as compared to 70% of bronchiolitis cases reported in worldwide literature (18). The reported prevalence of RSV bronchiolitis in the Kingdom of Saudi Arabia has wide variation between 25%–88%.
A study which was done in Abha Saudi Arabia showed that 128 (45.4%) of the 282 with bronchiolitis were found to be positive for RSV. This was lower as compare to our study which showed 61%, of patients were RSV positive. Their reported period of hospitalization was also similar to our study. Most frequent observed signs and symptoms of children positive for RSV were cough and tachypnea occurring in almost all of the patient. In our study cough was reported in 98% and tachypnea in 53% respectively. However, they noted fever in (81%) of their patients a higher proportion when compare to 59% in our study (19). No mortality was observed in our patients which was similar to observation made in one study (20). However, a study done in China showed 3.5% mortality in those patients admitted to ICU. High risk groups for mortality were identified especially children with congenital heart disease and trisomy 21(14,21).
Conclusion
Findings of our emergency department study on bronchiolitis are complementary to previously published data showing good prognosis in bronchiolitis. Although the percentage of patients needing admission to hospital was higher than previously reported but requirement of ICU admission is same. Majority of patient required admission for more than 48-hours which cause a major burden in short stay units in winter seasons. In institutions like King Abdul-Aziz university hospital which have a small bed capacity there is need to closely assess patient for admission in short stay unit. No deaths were seen although some patients had complications. Association between bronchiolitis and recurrent wheeze was seen in small group of children in our study. Further studies are needed to explore this association.
Acknowledgement
The author acknowledge the support provided by the research centre of College of Medicine, King Saud University, in preparation of this article.
References