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Three Part Question

In [children less than 2 years of age presenting to the ED with viral bronchiolitis] does [administration of corticosteroids] [improve clinical status and reduce hospitalization]?

Clinical Scenario

Parents bring their 10 month old, previously healthy infant to the ED after two days of fever, rhinorrhea, cough, and poor feeding. Today the infant is wheezing and has labored breathing. You wonder if administering corticosteroids will improve symptoms enough to allow discharge from the ED and outpatient management.

Search Strategy

Medline 1966 to 06/05 using OVID interface.
[bronchiolitis.mp. OR exp BRONCHIOLITIS, VIRAL OR exp BRONCHIOLITIS OR exp Bronchiolitis, Viral OR exp Respiratory Syncytial Virus Infections OR respiratory syncitial.mp. OR exp Respiratory Syncytial Viruses OR rsv.mp] AND [exp STEROIDS OR steroids.mp. OR adrenal cortex hormones.mp. OR exp Adrenal Cortex Hormones OR exp GLUCOCORTICOIDS OR "corticosteroid".mp. OR exp METHYLPREDNISOLONE OR methylprednisolone.mp. OR hydrocortisone.mp. OR exp HYDROCORTISONE/ OR exp DEXAMETHASONE/ OR dexamethasone.mp. OR prednisone.mp. OR exp PREDNISONE/] LIMIT to (human and english language and clinical trial)

Search Outcome

Altogether 54 papers were found, of which 53 were not relevant.

Comment(s)

Despite the high incidence of viral bronchiolitis, there is no consensus on optimal treatment. Studies of hospitalized patients have shown mixed results. A meta-analysis by Garrison et al in 2002 showed slightly decreased length of stay for inpatients. Until recently, studies had not been performed in an outpatient setting such as the ED. A 2002 study by Schuh et al demonstrated improvement in a validated clinical score at 4 hours after administering dexamethasone, as well as a lower rate of hospitalization. A more recent study by Csonka et al was also set in the ED, and showed shorter length of hospital stay. I did not include this study in my BET because it studied patients up to 35 months and those with a previous episode of wheezing, and did not assess outcomes in the outpatient setting.

Clinical Bottom Line

A single dose of dexamethasone (1mg/kg) may improve symptoms and reduce hospitalizations in infants who present to the ED with viral bronchiolitis.