A validated clinical model to predict the need for admission and length of stay in children with acute bronchiolitis.
OBJECTIVE
To develop and validate a logistic regression model to predict need for admission and length of hospital stay in children presenting to the Emergency Department with bronchiolitis.


METHODS
Two children's hospitals in Dublin, Ireland.


METHODS
We reviewed 118 episodes of bronchiolitis in 99 children admitted from the Emergency Department. Those discharged within 24 h by a consultant/attending paediatrician were retrospectively categorized as suitable for discharge. We then validated the model using a cohort of 182 affected infants from another paediatric Emergency Department in a bronchiolitis season 2 years later. In the validation phase actual admission, failed discharge, and age less than 2 months defined the need for admission.


RESULTS
The model predicted admission with 91% sensitivity and 83% specificity in the validation cohort. Age [odds ratio (OR) 0.86, 95% confidence interval (CI) 0.76-0.97], dehydration (OR 2.54, 95% CI 1.34-4.82), increased work of breathing (OR 3.39, 95% CI 1.29-8.92) and initial heart rate above the 97th centile (OR 3.78, 95% CI 1.05-13.57) predicted the need for admission and a longer hospital stay.


CONCLUSIONS
We derived and validated a severity of illness model for bronchiolitis. This can be used for outcome prediction in decision support tools or severity of illness stratification in research/audit.
Walsh
Paul
P
Department of Emergency Medicine, Kern Medical Centre, Bakersfield, CA, USA. yousentwhohome@netscape.net
Rothenberg
Stephen J
SJ
O'Doherty
Sinead
S
Hoey
Hilary
H
Healy
Roisin
R
D000208:Acute Disease; D000293:Adolescent; D017677:Age Distribution; D001988:Bronchiolitis / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D002648:Child; D002673:Child, Hospitalized / Q000706:statistics & numerical data*; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007494:Ireland / Q000453:epidemiology; D007902:Length of Stay / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D020380:Needs Assessment; D010343:Patient Admission / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution