title: Emergency Department Septic Screening in Respiratory Syncytial Virus (RSV) and Non-RSV Bronchiolitis.
abstract: OBJECTIVE
  To identify factors associated with culture-proven serious bacterial infection (SBI) and positive emergency department septic screening (EDSS) tests in children with bronchiolitis and to identify factors associated with the performance of EDSS.
  
  
  METHODS
  We reviewed an existing study database of patients with bronchiolitis. We defined a positive EDSS as urine with >/=10 WBC per high power field or cerebrospinal fluid (CSF) with >/=10 WBC per high power field (>25 WBC in neonates), or if organisms were identified on gram stain. We defined SBI as significant growth of an accepted pathogen in blood, urine or CSF. Our composite endpoint was positive if either of these was positive. The decision to perform testing was modeled using modified Poisson regression; the presence of the combined outcome was modeled using logistic regression modified for rare events.
  
  
  RESULTS
  We studied 640 children. Testing was performed in 199/640 (31.1%). These tended to be younger than two months RR 2.69 (95% CI 2.11, 3.44), febrile RR 2.01 (95% CI 1.58, 2.55), more dehydrated RR 1.50 (95% CI 1.28, 1.75) and had more severe chest wall retractions RR 1.54 (95% CI 1.22, 1.94). Only 11/640(1.7%) had a positive EDSS or SBI. Younger age (OR 0.67 per month; 95% CI 0.45, 0.99) and a negative RSV antigen test (OR 6.22; 95% CI 1.30, 29.85) were associated with the composite endpoint.
  
  
  CONCLUSIONS
  Testing was more likely to be performed in children younger than two months of age, and in those who were febrile, dehydrated, and had more severe chest wall retractions. A positive EDSS or SBI was rare occurring in younger infants with non-RSV bronchiolitis.
authors.affiliation: Kern Medical Center, Department of Emergency Medicine, Bakersfield, CA.
authors.forename: Chris
authors.initials: C
authors.lastname: Chee
authors.forename: Paul
authors.initials: P
authors.lastname: Walsh
authors.forename: Sam
authors.initials: S
authors.lastname: Kuan
authors.forename: Juanito
authors.initials: J
authors.lastname: Cabangangan
authors.forename: Kian
authors.initials: K
authors.lastname: Azimian
authors.forename: Christopher
authors.initials: C
authors.lastname: Dong
authors.forename: Joshua
authors.initials: J
authors.lastname: Tobias
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Rothenberg
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