title: Outpatient course and complications associated with home oxygen therapy for mild bronchiolitis.
abstract: BACKGROUND
  Home oxygen has been incorporated into the emergency department management of bronchiolitis in high-altitude settings. However, the outpatient course on oxygen therapy and factors associated with subsequent admission have not been fully defined.
  
  
  METHODS
  We conducted a retrospective cohort study in consecutive patients discharged on home oxygen from the pediatric emergency department at Denver Health Medical Center from 2003 to 2009. The integration of inpatient and outpatient care at our study institution allowed comprehensive assessment of follow-up rates, outpatient visits, time on oxygen, and subsequent admission. Admitted and nonadmitted patients were compared by using a χ(2) test and multivariable logistic regression.
  
  
  RESULTS
  We identified 234 unique visits with adequate follow-up for inclusion. The median age was 10 months (interquartile range [IQR]: 7-14 months). Eighty-three percent of patients were followed up within 24 hours and 94% within 48 hours. The median length of oxygen use was 6 days (IQR: 4-9 days), and the median number of associated encounters was 3 (range: 0-9; IQR: 2-3). Ninety-three percent of patients were on room air at 14 days. Twenty-two patients (9.4%) required subsequent admission. Fever at the initial visit (>38.0°C) was associated with admission (P < .02) but had a positive predictive value of 15.4%. Age, prematurity, respiratory rate, oxygen saturation, and history of previous bronchiolitis or wheeze were not associated with admission.
  
  
  CONCLUSIONS
  There is a significant outpatient burden associated with home oxygen use. Although fever was associated with admission, we were unable to identify predictors that could modify current protocols.
authors.affiliation: Division of Infectious Diseases, Boston Children's Hospital, Boston, Massachusetts; kelly.flett@childrens.harvard.edu.
authors.forename: Kelly B
authors.initials: KB
authors.lastname: Flett
authors.affiliation: Department of Ambulatory Care Services, Denver Health, Denver, Colorado; and.
authors.forename: Kristin
authors.initials: K
authors.lastname: Breslin
authors.affiliation: Department of Ambulatory Care Services, Denver Health, Denver, Colorado; and Department of Pediatrics, University of Colorado, Denver, Colorado.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Braun
authors.affiliation: Department of Ambulatory Care Services, Denver Health, Denver, Colorado; and Department of Pediatrics, University of Colorado, Denver, Colorado.
authors.forename: Simon J
authors.initials: SJ
authors.lastname: Hambidge
mesh_terms: D000531:Altitude; D001988:Bronchiolitis / Q000628:therapy*; D015331:Cohort Studies; D003120:Colorado; D004636:Emergency Service, Hospital; D005260:Female; D018575:Home Care Services, Hospital-Based; D006801:Humans; D007223:Infant; D007235:Infant, Premature, Diseases / Q000628:therapy; D008297:Male; D010102:Oxygen Inhalation Therapy / Q000379:methods*; D010359:Patient Readmission; D012189:Retrospective Studies; D012307:Risk Factors
keywords: bronchiolitis; emergency department; oxygen