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.
| Original language | English (US) |
|---|---|
| Article number | e20174253 |
| Journal | Pediatrics |
| Volume | 142 |
| Issue number | 3 |
| DOIs | |
| State | Published - Sep 2018 |
Funding
This was a planned secondary analysis of a multinational retrospective cohort study conducted at 38 pediatric EDs associated with the international Pediatric Emergency Research Networks (PERN), which consist of the following 6 collaborative networks: Pediatric Emergency Research Canada (PERC), the Pediatric Emergency Medicine Collaborative Research Committee (PEM-CRC) of the American Academy of Pediatrics, the Pediatric Emergency Care Applied Research Network (PECARN) in the United States, Pediatric Research in Emergency Departments International Collaborative (PREDICT) in Australia and New Zealand, Pediatric Emergency Research United Kingdom and Ireland (PERUKI), and Research in European Pediatric Emergency Medicine (REPEM).33 The original study was approved by the PERN Executive Committee and the research ethics boards of all participating hospitals. PERUKI: Fawaz Arshad, BMBS (Leicester Royal Infirmary Children’s Emergency Department, Leicester, UK); Carol Blackburn, MB BCh (Our Lady’s Children’s Hospital, Dublin, Ireland); Eleftheria Boudalaki, Ptychion Iatrikes (City Hospitals Sunderland National Health Service Foundation Trust, Sunderland, UK); Sian Copley, MBBS (City Hospitals Sunderland National Health Service Foundation Trust, Sunderland, UK); Kathryn Ferris, MB BCh BAO (Royal Belfast Hospital for Sick Children, Belfast, UK); Stuart Hartshorn, MB BChir (Birmingham Children’s Hospital, Birmingham, UK); Christopher Hine, MBChB (Birmingham Children’s Hospital, Birmingham, UK); Julie- Ann Maney, MB BCh BAO (Royal Belfast Hospital for Sick Children, Belfast, UK); Fintan McErlean (Royal Belfast Hospital for Sick Children, Belfast, UK); Niall Mullen, MB BCh (City Hospitals Sunderland National Health Service Foundation Trust, Sunderland, UK); Katherine Potier de la Morandiere, MBChB (Royal Manchester Children’s Hospital, Manchester, UK); Stephen Mullen, MB BCh BAO (Royal Belfast Hospital for Sick Children, Belfast, UK); Juliette Oakley, MB BCh (The Noah’s Ark Children’s Hospital for Wales, Cardiff, UK); Nicola Oliver, MBBS (Bristol Royal Hospital for Children, Bristol, UK); Colin Powell, MD (The Noah’s Ark Children’s Hospital for Wales, Cardiff, UK); Vandana Rajagopal, MBBS (The Noah’s Ark Children’s Hospital for Wales, Cardiff, UK); Shammi Ramlakhan, MBBS (Sheffield Children’s Hospital, Sheffield, UK); John Rayner, MBChB (Sheffield Children’s Hospital, Sheffield, UK); Sarah Raywood, MB BCh (Royal Manchester Children’s Hospital, Manchester, UK); Damian Roland, MBBS, (Leicester Royal Infirmary Children’s Emergency Department, Leicester, UK); Siobhan Skirka, MBChB (Our Lady’s Children’s Hospital, Crumlin, Dublin, UK); Joanne Stone, MBChB (Sheffield Children’s Hospital, Sheffield, UK).
ASJC Scopus subject areas
- Pediatrics, Perinatology, and Child Health