Prospective multicenter study of bronchiolitis: predicting safe discharges from the emergency department.
OBJECTIVE
Bronchiolitis is the leading cause of hospitalization for infants. Our objective was to identify factors associated with safe discharge to home from the emergency department.


METHODS
We conducted a prospective cohort study during 2 consecutive bronchiolitis seasons, from 2004 to 2006. Thirty US emergency departments contributed data. All patients were < 2 years of age and had a final emergency department attending physician diagnosis of bronchiolitis. Using multivariate logistic regression, a low-risk model was developed with a random half of the data and then validated with the other half.


RESULTS
Of 1456 enrolled patients, 837 (57%) were discharged home from the emergency department. The following factors predicted safe discharge to home: age of > or = 2 months, no history of intubation, a history of eczema, age-specific respiratory rates (< 45 breaths per minute for 0-1.9 months, < 43 breaths per minute for 2-5.9 months, and < 40 breaths per minute for 6-23.9 months), no/mild retractions, initial oxygen saturation of > or = 94%, fewer albuterol or epinephrine treatments in the first hour, and adequate oral intake. The importance of each factor varied slightly according to age, but the comprehensive model (developed and validated for all children < 2 years of age) yielded an area under the receiver operating characteristic curve of 0.81, with a good fit of the data.


CONCLUSIONS
This large multicenter study of children presenting to the emergency department with bronchiolitis identified several factors associated with safe discharge, including cut points for respiratory rate and oxygen saturation. Although the low-risk model requires further study, we believe that it will assist clinicians evaluating children with bronchiolitis and may help reduce some unnecessary hospitalizations.
Mansbach
Jonathan M
JM
Department of Medicine, Children's Hospital Boston, Boston, MA 02115, USA. jonathan.mansbach@childrens.harvard.edu
Clark
Sunday
S
Christopher
Norman C
NC
LoVecchio
Frank
F
Kunz
Sarah
S
Acholonu
Uchechi
U
Camargo
Carlos A
CA
D017677:Age Distribution; D001988:Bronchiolitis / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007223:Infant; D016015:Logistic Models; D008297:Male; D015337:Multicenter Studies as Topic; D015999:Multivariate Analysis; D010351:Patient Discharge / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D011336:Probability; D011446:Prospective Studies; D012720:Severity of Illness Index; D017678:Sex Distribution; D016896:Treatment Outcome