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Pediatrics. 2018 Sep;142(3). pii: e20174253. doi: 10.1542/peds.2017-4253. Epub 2018 Aug 20.

Predicting Escalated Care in Infants With Bronchiolitis.

Author information

1
Division of Pediatric Emergency Medicine, and.
2
Departments of Emergency Medicine and Pediatrics, School of Medicine, University of California, Davis, Sacramento, California.
3
Division of Pediatric Emergency Medicine, University of Ottawa and Children's Hospital of Eastern Ontario, Ottawa, Canada.
4
Emergency Department, Royal Children's Hospital, Murdoch Children's Research Institute, Parkville, Australia.
5
University of Melbourne, Melbourne, Australia.
6
Emergency Department, Starship Children's Hospital and the University of Auckland, Auckland, New Zealand.
7
Sections of Pediatric Emergency Medicine and Gastroenterology, Alberta Children's Hospital, Departments of Pediatrics, Alberta Children's Hospital Research Institute, Cumming School of Medicine, Calgary University, Calgary, Canada.
8
Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada.
9
Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, Canada.
10
Department of Pediatric Emergency Medicine, Hasbro Children's Hospital and Departments of Emergency Medicine, Pediatrics, and Health Services, Policy, and Practice, Brown University, Providence, Rhode Island.
11
Department of Pediatrics, Hospital de Santa Maria and Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, Instituto de Medicina Molecular, University of Lisbon, Lisbon, Portugal.
12
Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
13
Department of Pediatric Emergency Medicine, Children's Hospital of Minnesota, Minneapolis, Minnesota.
14
Emergency Department, Bristol Royal Hospital for Children and Faculty of Health and Applied Life Sciences, University of the West of England, Bristol, United Kingdom.
15
Sections of Pediatric Emergency Medicine, and Physiology and Pharmacology, Alberta Children's Hospital and Alberta Children's Hospital Research Institute, Cumming School of Medicine, Calgary University, Calgary, Canada.
16
Department of Pediatric Emergency Medicine, School of Medicine, Washington University in St Louis, St Louis, Missouri.
17
Department of Pediatric Emergency Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas; and.
18
Pediatric Emergency Department, Cruces University Hospital, Barakaldo, Spain.
19
Division of Pediatric Emergency Medicine, and suzanne.schuh@sickkids.ca.

Abstract

BACKGROUND AND OBJECTIVES:

Early risk stratification of infants with bronchiolitis receiving airway support is critical for focusing appropriate therapies, yet the tools to risk categorize this subpopulation do not exist. Our objective was to identify predictors of "escalated care" in bronchiolitis. We hypothesized there would be a significant association between escalated care and predictors in the emergency department. We subsequently developed a risk score for escalated care.

METHODS:

We conducted a retrospective cohort study of previously healthy infants aged <12 months with bronchiolitis. Our primary outcome was escalated care (ie, hospitalization with high-flow nasal cannula, noninvasive or invasive ventilation, or intensive care admission). The predictors evaluated were age, prematurity, day of illness, poor feeding, dehydration, apnea, nasal flaring and/or grunting, respiratory rate, oxygen saturation, and retractions.

RESULTS:

Of 2722 patients, 261 (9.6%) received escalated care. Multivariable predictors of escalated care were oxygen saturation <90% (odds ratio [OR]: 8.9 [95% confidence interval (CI) 5.1-15.7]), nasal flaring and/or grunting (OR: 3.8 [95% CI 2.6-5.4]), apnea (OR: 3.0 [95% CI 1.9-4.8]), retractions (OR: 3.0 [95% CI 1.6-5.7]), age ≤2 months (OR: 2.1 [95% CI 1.5-3.0]), dehydration (OR 2.1 [95% CI 1.4-3.3]), and poor feeding (OR: 1.9 [95% CI 1.3-2.7]). One of 217 (0.5%) infants without predictors received escalated care. The risk score ranged from 0 to 14 points, with the estimated risk of escalated care from 0.46% (0 points) to 96.9% (14 points). The area under the curve was 85%.

CONCLUSIONS:

We identified variables measured in the emergency department predictive of escalated care in bronchiolitis and derived a risk score to stratify risk of this outcome. This score may be used to aid management and disposition decisions.

PMID:
30126934
DOI:
10.1542/peds.2017-4253

Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

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