Pediatric Hospitalist Akron Children's Hospital Akron, Ohio, United States
Background: Bronchiolitis is a significant cause of hospitalization in children, accounting for more than $700 million in annual healthcare costs. Procalcitonin (PCT) has garnered recent interest in pediatrics and has demonstrated potential in decreasing antibiotic usage in other illness, such as sepsis and bacterial pneumonia. However, its precise role in bronchiolitis remains uncertain. Objective: This study aimed to analyze the use of PCT among patients presenting to the emergency department with a diagnosis of bronchiolitis, with the hypothesis that the annual use of PCT would increase but would not be associated with changes in admission rates or antimicrobial use. Design/Methods: We conducted a multicenter, retrospective cross-sectional study utilizing the Pediatric Health Information Systems (PHIS) database. Infants aged 2-23 months presenting with bronchiolitis from January 1, 2016 to December 31, 2022 were included. Encounters with and without PCT testing were compared using chi-squared testing and Wilcoxon Rank-Sum testing as appropriate. Temporal trends in PCT testing and correlations with admission proportions and antimicrobial use were compared using linear regression. Results: There were 482,796 bronchiolitis encounters among 388,456 distinct patients across 42 hospitals during the study period. Of those 2.6% (12,485/482,796) had PCT testing performed. PCT usage increased more than 16-fold between 2016 and 2022 (0.3% in 2016 versus 4.9% in 2022, p < 0.001) (Figure 1). PCT use ranged from 0.03% to 11.4% across hospitals and was associated with increased admissions (adjusted r2 = 0.826, p = 0.002) but not with increased antimicrobial use (adjusted r2 = 0.367, p = 0.088) (Figure 2).
Conclusion(s): PCT testing in patients with bronchiolitis has increased 16-fold between 2016-2022 and has not been associated with a decrease in antimicrobial prescriptions. Further studies are needed to determine the diagnostic yield of PCT in bronchiolitis.
