title: Risk factors for requiring intensive care among children admitted to ward with bronchiolitis.
abstract: OBJECTIVE
  To examine risk factors for transfer of bronchiolitis patients from the ward to the intensive care unit (ICU) and/or initiation of critical care interventions.
  
  
  METHODS
  We performed a 16-center, prospective cohort study of hospitalized children age <2 years with bronchiolitis. During the winters of 2007 to 2010, researchers collected clinical data and nasopharyngeal aspirates from study participants. The primary outcome was late intensive care use, defined as a transfer to the ICU and/or use of mechanical ventilation (regardless of location) after the child's first inpatient day.
  
  
  RESULTS
  Among 2104 children hospitalized with bronchiolitis, 1762 (84%) were identified as initial ward patients, comprising the analysis cohort. The median age was 4 months (interquartile range, 2-9 months), and 1048 (59%) were boys. The most frequently detected pathogens were respiratory syncytial virus (72%) and rhinovirus (25%). After the first inpatient day, 47 (3%; 95% confidence interval, 2-4) were subsequently transferred to the ICU or required mechanical ventilation. In the multivariable logistic regression model predicting subsequent transfer to the ICU or mechanical ventilation use, the significant predictors were birth weight <5 pounds (odds ratio, 2.28; 95% confidence interval, 1.30-4.02; P = .004) and respiratory rate high of ≥ 70 breaths/min on the first inpatient day (odds ratio, 4.64; 95% confidence interval, 2.86-7.53; P < .001).
  
  
  CONCLUSIONS
  In this multicenter study of children hospitalized with bronchiolitis, low birth weight and tachypnea were significantly associated with subsequent transfer to the ICU and/or use of mechanical ventilation.
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass. Electronic address: khasegawa1@partners.org.
authors.forename: Kohei
authors.initials: K
authors.lastname: Hasegawa
authors.affiliation: Department of Pediatrics, Children's Mercy Hospital, Kansas City, Mo.
authors.forename: Brian M
authors.initials: BM
authors.lastname: Pate
authors.affiliation: Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Mass.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Mansbach
authors.affiliation: Department of Pediatrics, Section of Emergency Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex.
authors.forename: Charles G
authors.initials: CG
authors.lastname: Macias
authors.affiliation: Department of Pediatrics, Rady Children's Hospital, University of California San Diego, Calif.
authors.forename: Erin S
authors.initials: ES
authors.lastname: Fisher
authors.affiliation: Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Tex; Department of Pediatrics, Baylor College of Medicine, Houston, Tex.
authors.forename: Pedro A
authors.initials: PA
authors.lastname: Piedra
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.
authors.forename: Janice A
authors.initials: JA
authors.lastname: Espinola
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.
authors.forename: Ashley F
authors.initials: AF
authors.lastname: Sullivan
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Camargo
mesh_terms: D001988:Bronchiolitis / Q000453:epidemiology / Q000628:therapy*; D002675:Child, Preschool; D003422:Critical Care / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D010360:Patient Transfer / Q000706:statistics & numerical data; D010850:Picornaviridae Infections / Q000453:epidemiology / Q000628:therapy*; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000706:statistics & numerical data*; D018357:Respiratory Syncytial Virus Infections / Q000453:epidemiology / Q000628:therapy*; D012307:Risk Factors; D059246:Tachypnea / Q000453:epidemiology
keywords: bronchiolitis; hospitalization; intensive care unit; mechanical ventilation; risk factors