Prospective multicenter study of bronchiolitis: predictors of an unscheduled visit after discharge from the emergency department.
OBJECTIVE
There is little evidence about which children with bronchiolitis will have worsened disease after discharge from the emergency department (ED). The objective of this study was to determine predictors of post-ED unscheduled visits.


METHODS
The authors conducted a prospective cohort study of patients discharged from 2004 to 2006 at 30 EDs in 15 U.S. states. Inclusion criteria were diagnosis of bronchiolitis, age <2 years, and discharge home; the exclusion criterion was previous enrollment. Unscheduled visits were defined as urgent visits to an ED/clinic for worsened bronchiolitis within 2 weeks.


RESULTS
Of 722 patients eligible for the current analysis, 717 (99%) had unscheduled visit data, of whom 121 (17%; 95% confidence interval [CI] = 14% to 20%) had unscheduled visits. Unscheduled visits were more likely for children age <2 months (11% vs. 6%; p = 0.04), males (70% vs. 57%; p = 0.007), and those with history of hospitalization (27% vs. 18%; p = 0.01). The two groups were similar in other demographic and clinical factors (all p > 0.10). Using multivariable logistic regression, independent predictors of unscheduled visits were age <2 months, male, and history of hospitalization.


CONCLUSIONS
In this study of children age younger than 2 years with bronchiolitis, one of six children had unscheduled visits within 2 weeks of ED discharge. The three predictors of unscheduled visits were age under 2 months, male sex, and previous hospitalization.
Norwood
Agatha
A
Department of Medicine, Children's Hospital Boston, Harvard Medical School, Boston, MA, USA.
Mansbach
Jonathan M
JM
Clark
Sunday
S
Waseem
Muhammad
M
Camargo
Carlos A
CA
D000367:Age Factors; D001071:Appointments and Schedules; D001988:Bronchiolitis / Q000175:diagnosis / Q000628:therapy*; D015331:Cohort Studies; D016001:Confidence Intervals; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009819:Office Visits / Q000706:statistics & numerical data*; D010343:Patient Admission / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D011336:Probability; D011446:Prospective Studies; D012008:Recurrence; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome