title: The modified respiratory index score (RIS) guides resource allocation in acute bronchiolitis.
abstract: Bronchiolitis is a common disease in early childhood with increasing healthcare utilization. We aim to study how well a simple and improved respiratory score (the modified Respiratory Index Score [RIS]) would perform when predicting for a warranted admission.
  
  
  
  This is an observational prospective study, from June 2015 to December 2015 in a paediatric emergency department (ED) of a large tertiary hospital in Singapore. We included children aged less than 2 years old, presenting with typical symptoms and signs of bronchiolitis but excluded children with four or more previous wheezes, a gestation of <35 weeks, and known cardiopulmonary disease. We also performed a sensitivity analysis for children presenting with their first wheeze. We defined a warranted admission as a composite of: The need for airway intervention, intravenous hydration, and a hospital stay of 2 days or more.
  
  
  
  Among 1,818 patients, the median age was 10.8 months (IQR 7.2-15.9). The median modified RIS score was 4.0 (IQR 3.0-5.0). A total of 19 (1.0%) children required respiratory support, 101 (5.6%) received intravenous hydration, and 571 (31.4%) required a hospital stay of 2 days or more. After adjusting for age and duration of illness, a modified RIS score of >4 predicted significantly for a warranted admission (adjusted Odds Ratio: 3.28, 95% confidence interval: 2.62-4.12). The association remained significant among children presenting with their first wheeze.
  
  
  
  This simple respiratory tool predicts for the need for respiratory support, intravenous hydration, and a significant hospital stay of 2 days or more. Pediatr Pulmonol. 2017; 52:954-961. © 2017 Wiley Periodicals, Inc.
authors.affiliation: Department of Emergency Medicine, KK Women's and Children's Hospital, Duke-NUS Medical School, Singapore.
authors.forename: Shu-Ling
authors.initials: SL
authors.lastname: Chong
authors.affiliation: Department of Paediatrics, Respiratory Medicine Service, KK Women's and Children's Hospital, Duke-NUS Medical School, Singapore.
authors.forename: Oon Hoe
authors.initials: OH
authors.lastname: Teoh
authors.affiliation: Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore.
authors.forename: Nivedita
authors.initials: N
authors.lastname: Nadkarni
authors.affiliation: Division of Medicine, KK Women's and Children's Hospital, Duke-NUS Medical School, Singapore.
authors.forename: Joo Guan
authors.initials: JG
authors.lastname: Yeo
authors.affiliation: Department of Emergency Medicine, KK Women's and Children's Hospital, Duke-NUS Medical School, Singapore.
authors.forename: Zaw
authors.initials: Z
authors.lastname: Lwin
authors.affiliation: Department of Emergency Medicine, KK Women's and Children's Hospital, Duke-NUS Medical School, Singapore.
authors.forename: Yong-Kwang Gene
authors.initials: YG
authors.lastname: Ong
authors.affiliation: Children's Intensive Care Unit, KK Women's and Children's Hospital, Duke-NUS Medical School, Singapore.
authors.forename: Jan Hau
authors.initials: JH
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D001988:Bronchiolitis; D002648:Child; D004636:Emergency Service, Hospital; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D012720:Severity of Illness Index; D012846:Singapore; D062606:Tertiary Care Centers
keywords: bronchiolitis; clinical prediction rule; decision support techniques