IMPORTANCE Over the last 2 decades, bronchiolitis guidelines and improvement efforts focused on supportive care and reducing unnecessary tests, treatments, and hospitalization. There have been limited population-based studies examining hospitalization outcomes over time. OBJECTIVE To describe rates and trends in bronchiolitis hospitalization, intensive care unit (ICU) use, mortality, and costs. DESIGN, SETTING, AND PARTICIPANTS This cohort study used population-based health administrative data from April 1, 2004, to March 31, 2018, to identify bronchiolitis encounters using hospital discharge diagnosis codes in Ontario, Canada. Children younger than 2 years with and without bronchiolitis hospitalization were included. Data were analyzed from January 2020 to July 2021. MAIN OUTCOMES AND MEASURES Bronchiolitis hospitalization per 1000 person-years, ICU use per 1000 hospitalizations, mortality per 100 000 person-years, and costs per 1000 person-years adjusted to 2018 Canadian dollars and reported in 2018 US dollars.RESULTS Among 2 336 446 included children, 1 199 173 (51.3%) were male. During the study period, 43 993 children (1.9%) younger than 2 years had 48 058 bronchiolitis hospitalizations at 141 hospitals. Bronchiolitis accounted for 48 058 of 360 920 all-cause hospitalizations (13.3%) and 215 654 of 2 566 348 all-cause hospital days (8.4%) in children younger than 2 years. Bronchiolitis hospitalization was stable over time, at 14.0 (95% CI, 13.6-14.4) hospitalizations per 1000 person-years in 2004-2005 and 12.7 (95% CI, 12.2-13.1) hospitalizations per 1000 person-years in 2017-2018 (annual percent change [APC], 0%;

IMPORTANCEIdentifying conditions that could be prioritized for research based on health care system burden is important for developing a research agenda for the care of hospitalized children.However, existing prioritization studies are decades old or do not include data from both pediatric and general hospitals. OBJECTIVE To assess the prevalence, cost, and variation in cost of pediatric hospitalizations at all general and pediatric hospitals in Ontario, Canada, with the aim of identifying conditions that could be prioritized for future research. DESIGN, SETTING, AND PARTICIPANTSThis population-based cross-sectional study used health administrative data from 165 general and pediatric hospitals in Ontario, Canada. Children younger than 18 years with an inpatient hospital encounter between April 1, 2014, and March 31, 2019, were included. MAIN OUTCOMES AND MEASURESCondition-specific prevalence, cost of pediatric hospitalizations, and condition-specific variation in cost per inpatient encounter across hospitals.Variation in cost was evaluated using (1) intraclass correlation coefficient (ICC) and (2) number of outlier hospitals. Costs were adjusted for inflation to 2018 US dollars. RESULTSOverall, 627 314 inpatient hospital encounters (44.8% among children younger than 30 days and 53.0% among boys) at 165 hospitals (157 general and 8 pediatric) costing $3.3 billion were identified. A total of 408 003 hospitalizations (65.0%) and $1.4 billion (43.8%) in total costs occurred at general hospitals. Among the 50 most prevalent and 50 most costly conditions (of 68 total conditions), the top 10 highest-cost conditions accounted for 55.5% of all costs and 48.6% of all encounters. The conditions with highest prevalence and cost included low birth weight (86.

Key Points Question What are the highest-priority unanswered research questions in pediatric hospital medicine from the perspective of young people, parents/caregivers, and health care professionals? Findings This study, which included 2 surveys and a final consensus meeting using nominal group technique, gathered the perspectives of youths, parents/caregivers, and clinicians. The top 10 questions identified focused on the care of special inpatient populations (eg, children with medical complexity), communication, shared decision-making, support strategies, mental health supports, reducing time in the hospital, and supporting Indigenous families. Meaning The findings of this study suggest that the most important research questions in pediatric hospital medicine focus on processes and models of care, communication, and hospitalization outcomes.

ImportancePulse oximetry is a noninvasive technology that is integral to the supportive care of hospitalized infants with bronchiolitis. A multicenter, randomized trial comparing the effectiveness of intermittent vs continuous pulse oximetry found similar length of hospital stay and safety outcomes, and greater nursing satisfaction, with intermittent monitoring.ObjectivesTo evaluate the cost-effectiveness of intermittent vs continuous pulse oximetry in hospitalized infants with stabilized bronchiolitis.Design, Setting, and ParticipantsAn economic evaluation concurrent with a randomized trial in community and tertiary children’s hospitals in Ontario, Canada, was conducted using a probabilistic analysis. Patients were enrolled from November 1, 2016, to May 31, 2019. Data included infants aged 4 weeks to 24 months hospitalized with bronchiolitis, with or without supplemental oxygen, after stabilization. The cost-effectiveness analysis adopted a societal and health care system perspective and a time horizon from hospitalization to 15 days post-discharge. Patient level direct health care costs and indirect costs were included. Health resource use, costs, and clinical outcomes were obtained from trial data. Publicly available pricing resources were used to supplement costs. Ranges for sensitivity analysis were based on 95% confidence intervals of the trial data. All costs were reported in 2021 Canadian dollars.InterventionsIntermittent (every 4 hours) vs continuous pulse oximetry using an oxygen saturation target of 90% or higher.Main Outcomes and MeasuresCosts and incremental costs.ResultsTrial data from 229 infants (median [IQR] age, 4.0 [2.2-8.5] months; 136 boys [59.4%], 93 girls [40.6%]) were included. Mean societal costs per patient were $6879 (95% CI, $3393 to $12 317) in the intermittent and $7428 (95% CI, $1743 to $25 011) in the continuous group with a mean incremental cost of −$548 (95% CI, −$18 486 to $8105). Mean health care system costs per patient were $4195 (95% CI, $1191 to $9461) in the intermittent and $4716 (95% CI, $335 to $22 093) in the continuous group (incremental cost, −$520; 95% CI, −$18 286 to $7358). The mean effect measure of length of stay was similar between the 2 groups: 37.4 hours (95% CI, 1.0 to 137.7 hours) in the intermittent group and 38.5 hours (95% CI, 0 to 237.1 hours) in the continuous group. One-way sensitivity analyses on all variables revealed that the findings were robust and the incremental costs were not sensitive to the uncertainty within the defined ranges.Conclusions and RelevanceIn this prospective economic evaluation study, we found that costs were similar for intermittent and continuous pulse oximetry considering societal and health care perspectives. Given that clinical outcomes between monitoring strategies are comparable and that other practice considerations favor intermittent monitoring, these findings provide additional information that support the use of intermittent monitoring in hospitalized infants with stabilized bronchiolitis.

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