Aim The most common cause of infant hospitalization during the first six months of life in the United States and Europe, Bronchiolitis is largely caused by Respiratory Syncytial Virus (RSV). Diagnosis is clinically based, with limited reliance on lab and radiological tests. Aim: To evaluate the frequency of patient investigations in clinically diagnosed bronchiolitis at the UHL Emergency Department, comparing results with international guidelines (NICE, RCH) and local protocols.

Material and Method Retrospective data collection of children (<2years) with respiratory difficulties was conducted from December 1st-31st, 2022. Anonymization was performed following local audit guidelines on patient charts, local laboratories, and radiology services.

Results Among the 72 patients analysed, 71% (51/72) were under one year old, and 29% (21/72) were over one year old. Males constituted 61% (44/72), and females 39% (28/72). Of those admitted, 69% (11/16) were below one year, and 31% (5/16) above one year. Severe bronchiolitis was observed in 3% (2/72), mild symptoms in 82% (59/71), and moderate symptoms in 15% (11/72). Nasal swabs conducted in 25% of patients revealed 61% (18/72) RSV detection, 17%(3/18) Influenza, and the remainder of Adenovirus, Rhino/Enterovirus, or a combination. Regarding investigations, 50% (36/72) underwent chest X-rays, with 11% (4/72) demonstrating clinical indications. 39% (14/36) of these X-rays showed normal findings, 47% (17/36) showed viral changes, and 14% (5/36) showed potential pneumonic changes. Blood tests conducted in 15% (11/72) of patients, clinical indications were present in 27% (3/11). ED admissions were 22% (16/72), with 69% (11/16) meeting RCH criteria, and 21% (15/72) receiving antibiotics without indications.

Conclusions The audit reveals suboptimal adherence to bronchiolitis management guidelines. To achieve 95% compliance. A comprehensive bronchiolitis pathway will be incorporated into our local guidelines, supported by education. It aims to guide medical staff, optimize investigations, reduce unnecessary tests, and maximize healthcare resources. We will re-audit after implementation to improve patient care.