how do you diagnose bronchiolitis ? is that just any obvious virus? Given it is a clinical dx the PPV is likely not super high . Yet runny nose and cough puts them in that category?
It seems it shouldn't be very sensitive, but it is! In the studies looking at risk of SBI using clinical vs viral panel bronchiolitis, the rates are the same. It turns out that we are quite good- probably as good as viral testing at picking up bronchiolitis. Of course, there are subtle cases we might miss, but then those kids get a fever work-up. But for the kid with a few days of significant nasal congestion, low-ish fever (usually in the 38.5-39ish range, reactive sounding cough with lungs that sounds like a washing machine (diffuse inspiratory junkiness and diffuse expiratory wheeze or junkiness)- I'd feel very confident (in the face of no other. gross. abnormalities on exam) calling that bronchiolitis.
Andy: Bronchiolitis can be distinguished by its lower respiratory signs and findings (eg, wheezes), mimicking asthma. It is indeed a clinical diagnosis.
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Andy M. B. - February 25, 2023 11:10 PM
how do you diagnose bronchiolitis ? is that just any obvious virus? Given it is a clinical dx the PPV is likely not super high . Yet runny nose and cough puts them in that category?
ilene c. - February 27, 2023 8:38 AM
It seems it shouldn't be very sensitive, but it is! In the studies looking at risk of SBI using clinical vs viral panel bronchiolitis, the rates are the same. It turns out that we are quite good- probably as good as viral testing at picking up bronchiolitis. Of course, there are subtle cases we might miss, but then those kids get a fever work-up. But for the kid with a few days of significant nasal congestion, low-ish fever (usually in the 38.5-39ish range, reactive sounding cough with lungs that sounds like a washing machine (diffuse inspiratory junkiness and diffuse expiratory wheeze or junkiness)- I'd feel very confident (in the face of no other. gross. abnormalities on exam) calling that bronchiolitis.
Stuart S., MD FRCPC - February 27, 2023 8:40 AM
Andy: Bronchiolitis can be distinguished by its lower respiratory signs and findings (eg, wheezes), mimicking asthma. It is indeed a clinical diagnosis.