title: Hospital course and discharge criteria for children hospitalized with bronchiolitis.
abstract: BACKGROUND
  For children hospitalized with bronchiolitis, there is uncertainty about the expected inpatient clinical course and when children are safe for discharge.
  
  
  OBJECTIVE
  Examine the time to clinical improvement, risk of clinical worsening after improvement, and develop discharge criteria.
  
  
  METHODS
  Prospective multiyear cohort study.
  
  
  METHODS
  Sixteen US hospitals.
  
  
  METHODS
  Consecutive hospitalized children age <2 years with bronchiolitis.
  
  
  METHODS
  We defined clinical improvement using: (1) retraction severity, (2) respiratory rate, (3) room air oxygen saturation, and (4) hydration status. After meeting improvement criteria, children were considered clinically worse based on the inverse of ≥1 of these criteria or need for intensive care.
  
  
  RESULTS
  Among 1916 children, the median number of days from onset of difficulty breathing until clinical improvement was 4 (interquartile range, 3-7.5 days). Of the total, 1702 (88%) met clinical improvement criteria, with 4% worsening (3% required intensive care). Children who worsened were age <2 months (adjusted odds ratio [AOR]: 3.51; 95% confidence interval [CI]: 2.07-5.94), gestational age <37 weeks (AOR: 1.94; 95% CI: 1.13-3.32), and presented with severe retractions (AOR: 5.55; 95% CI: 2.12-14.50), inadequate oral intake (AOR: 2.54; 95% CI: 1.39-4.62), or apnea (AOR: 2.87; 95% CI: 1.45-5.68). Readmissions were similar for children who did and did not worsen.
  
  
  CONCLUSIONS
  Although children hospitalized with bronchiolitis had wide-ranging recovery times, only 4% worsened after initial improvement. Children who worsened were more likely to be younger, premature infants presenting in more severe distress. For children hospitalized with bronchiolitis, these data may help establish more evidence-based discharge criteria, reduce practice variability, and safely shorten hospital length-of-stay.
authors: Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
authors: Jonathan M
authors: JM
authors: Mansbach
authors: Sunday
authors: S
authors: Clark
authors: Pedro A
authors: PA
authors: Piedra
authors: Charles G
authors: CG
authors: Macias
authors: Alan R
authors: AR
authors: Schroeder
authors: Brian M
authors: BM
authors: Pate
authors: Ashley F
authors: AF
authors: Sullivan
authors: Janice A
authors: JA
authors: Espinola
authors: Carlos A
authors: CA
authors: Camargo
mesh_terms: D001988:Bronchiolitis / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006760:Hospitalization / Q000639:trends; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000639:trends; D008297:Male; D010351:Patient Discharge / Q000592:standards* / Q000639:trends; D011446:Prospective Studies
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