Predictors of major intervention in infants with bronchiolitis.
OBJECTIVE
We sought to identify predictors of the major medical intervention (MMI) in infants with bronchiolitis in the Emergency Department (ED) to recognize those in need of hospitalization versus the candidates for discharge.


METHODS
We conducted an analysis of data from a prospective cohort study of previously healthy infants 2-23 months presenting to our ED with first episode of wheeze and respiratory distress. Infants were divided into those with at least one MMI defined as oxygen administration for saturation of <90%, intravenous (IV) fluids of 20 ml/kg, apnea management, or critical care unit (CCU) admission (MMI group) versus those without (no-MMI group). The primary outcome was the association between the MMI versus no-MMI groups and potential risk factors for these outcomes.


RESULTS
Of 312 study infants, 52 experienced MMI--all received oxygen for saturation <90%, four also received IV fluids and none required apnea management or CCU care. The following four risk factors were associated with MMI: baseline accessory muscle score >or=6/9 [OR 2.44, 95% CI 1.29; 4.62], oxygen saturation <or=92% [OR 2.41, 95% CI 0.96; 6.14], respiratory rate >or=60 [OR 1.85, 95% CI 0.97; 3.54], and poor fluid intake [OR 2.65, 95% CI 1.12; 6.26]. Of the 148 infants without predictors 11 (7.4%) received MMI, 145 required either no MMI or oxygen for <or=6 hr and 130 (87.8%) stayed for <or=12 hr.


CONCLUSIONS
Infants with bronchiolitis with high-risk predictors should be hospitalized whereas those without can be considered for outpatient management due to low-risk of MMI.
Parker
Melissa J
MJ
Division of Pediatric Emergency Medicine, Research Institute, The Hospital for Sick Children, University of Toronto, Ontario, Canada.
Allen
Upton
U
Stephens
Derek
D
Lalani
Amina
A
Schuh
Suzanne
S
D000208:Acute Disease; D001049:Apnea / Q000453:epidemiology / Q000628:therapy; D001988:Bronchiolitis / Q000175:diagnosis / Q000628:therapy*; D016022:Case-Control Studies; D015897:Comorbidity; D003422:Critical Care / Q000379:methods / Q000706:statistics & numerical data*; D003681:Dehydration / Q000453:epidemiology / Q000628:therapy; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005440:Fluid Therapy / Q000706:statistics & numerical data; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000706:statistics & numerical data; D010092:Oximetry / Q000706:statistics & numerical data; D010102:Oxygen Inhalation Therapy / Q000706:statistics & numerical data; D010343:Patient Admission / Q000706:statistics & numerical data*; D010351:Patient Discharge / Q000706:statistics & numerical data; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012307:Risk Factors; D012720:Severity of Illness Index