Chest auscultatory signs in infants presenting to A&E with bronchiolitis

BACKGROUND: Anecdotally it has been noted that the traditional chest signs associated with bronchiolitis appear inconsistently in infants clinically diagnosed with bronchiolitis. We wished to explore this more formally. OBJECTIVE: The aim of this study was to assess whether the auscultatory chest signs at presentation in infants with bronchiolitis were influenced by age or by the underlying pathogen. MATERIALS AND METHODS: We conducted a prospective opportunistic cohort study, recruiting infants less than 12 months old who presented with bronchiolitis to the Emergency Department of the Royal Hospital for Sick Children in Edinburgh. RESULTS: Eighty-six infants were recruited. Infants who presented with wheeze were significantly older [26.6 (±1.9) weeks] than those without wheeze [17.3 (±2.1) weeks] (analysis of variance, P=0.002). Those who presented without any chest signs on auscultation were younger than those with chest signs [15.1 (±2.6) weeks compared with 24.4 (±1.7) weeks] (analysis of variance, P=0.006). We did not detect any difference in any of the auscultatory chest signs (crackles, wheeze or absence of signs) depending on the virus responsible for bronchiolitis. CONCLUSION: Clinical signs associated with bronchiolitis vary according to age. Infants older than 6 months are more likely to present with wheeze and infants less than 4 months old are likely to present without chest signs on auscultation.