Trend of accesses to the Emergency Department of a Teaching Hospital of Tuscany due to bronchiolitis in 2018-2023: new challenges.

Introduction: Acute bronchiolitis is one of leading causes of lower respiratory tract infection and hospitalisation in children less than one year old worldwide. The aim of our study is investigating the impact of bronchiolitis in children paediatric to the Emergency Department (ED) of Teaching Hospital (AOUS), Santa Maria alle Scotte of Siena, Tuscany (Italy). Methods: A retrospective observational study was conducted on the accesses performed at the ED of the AOUS of Siena by children under 18 years of age suffering from bronchiolitis from September 2018 to April 2023. Results: There were 36,031 patients between 0 and 18 years old in the Emergency Department, 383 of which presented bronchiolitis (age 4.8 months C.I.:3.5-6 months.; 54% male). Those who accessed the ED with a higher priority code were more likely to be subsequently admitted (O.R.:2.6; C.I.:1.3-5.1; p < 0.01). Those who accessed the ED with symptoms of bronchiolitis during the weekend were less likely to have been sent from community medicine services or professionals (O.R:0.1; C.I:0.0-0.5; p < 0.001). Children below 1 year old were more likely to access the ED with respiratory distress symptoms (O.R.:2.6; C.I.:1.5-4.3; p < 0.001). Finally, those who accessed the ED with bronchiolitis were more likely to be admitted than those who accessed for other conditions (O.R:24.5; C.I.:19.4-31; p < 0.001). Conclusions: It is necessary to invest protocols integrating hospital services and community medicine in order to achieve a timely diagnosis and to reduce the accesses to the ED of children presenting mild, non-severe form of bronchiolitis in order to avoid the overload of hospital services.