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Bronchiolitis is a source of unique fascination for health services researchers. Partly this is due to its ubiquity, as the single most common cause of children being admitted to hospital and to paediatric intensive care units in the UK and USA. Partly it is the fact that, for the overwhelming majority of affected infants, treatment is supportive, despite the historical procession of postulated treatments and vaccines which so far have had no impact on prevention or outcome. Thus, health professionals and health services researchers have concentrated their efforts on reducing unnecessary medical intervention such as use of antibiotics, bronchodilators or chest X-rays.
Green et al contribute to the literature on healthcare utilisation in bronchiolitis with their retrospective analysis of hospital admissions in England over five decades.1 The triangulation of several data sets adds robustness to their finding that hospital admission rates for bronchiolitis have risen nearly sevenfold in 32 years. This correlates broadly with similar literature on trends in hospitalisation for bronchiolitis in other countries.2
The first question that arises is whether this reflects a true increase in hospital utilisation. Coding of administrative hospital data in England is variable but improving over time, which may represent a potential source of bias. However, the degree of increase makes this less plausible. Furthermore, if clinicians were getting better at coding bronchiolitis admissions over time, one would expect to see an associated inverse trend for lower admissions for other lower respiratory tract infections (LRTIs) in that period. In fact, absolute …