title: Emergency Department-initiated Home Oxygen for Bronchiolitis: A Prospective Study of Community Follow-up, Caregiver Satisfaction, and Outcomes.
abstract: Retrospective studies have shown home oxygen to be a safe alternative to hospitalization for some patients with bronchiolitis living at high altitudes. We aimed to prospectively describe adverse events, follow-up, duration of home oxygen, factors associated with failure, and caregiver preferences.
  
  
  
  This was a prospective observational study of hypoxemic bronchiolitis patients ages 3 to 18 months who were discharged from a tertiary care pediatric emergency department on home oxygen over three winters (2011-2014). Caregivers were contacted on postdischarge days ~3, 7, 14, and 28 while on oxygen.Caregivers not reached by phone were sent a survey and their primary care physicians were contacted. Records of admitted subjects were reviewed. Outcome measures included hospital readmission, positive pressure ventilation (noninvasive or intubation), outpatient follow-up, duration of home oxygen therapy, and caregiver satisfaction.
  
  
  
  A total of 274 patients were enrolled. Forty-eight (17.5%) were admitted and 225 (82.1%) were discharged on oxygen. The median age was 8 months. Eighteen subjects were lost to follow-up. A total of 196 (87.1%) were successfully treated with outpatient oxygen, and 11 (4.9%) failed outpatient therapy and were hospitalized. Only one hospitalized patient required invasive ventilation. The median duration of home oxygen was 7 days. Child noncompliance was the most common problem (reported by 14%). The median caregiver comfort level with home oxygen was 9 of 10. Eighty-eight percent of caregivers would again choose home oxygen over admission.
  
  
  
  This study confirms that outpatient oxygen therapy can reduce hospitalizations due to bronchiolitis in a relatively high-altitude setting, with low failure and complication rates. Caregivers are comfortable with home oxygen and prefer it to hospitalization.
authors.affiliation: Department of Pediatrics, Section of Emergency Medicine, University of Colorado Denver, Aurora, CO.
authors.forename: Julia Fuzak
authors.initials: JF
authors.lastname: Freeman
authors.affiliation: Research Institute, Children's Hospital Colorado, Aurora, CO.
authors.forename: Sara
authors.initials: S
authors.lastname: Deakyne
authors.affiliation: Department of Pediatrics, Section of Emergency Medicine, University of Colorado Denver, Aurora, CO.
authors.forename: Lalit
authors.initials: L
authors.lastname: Bajaj
mesh_terms: D000553:Ambulatory Care / Q000706:statistics & numerical data; D001988:Bronchiolitis / Q000628:therapy*; D017028:Caregivers / Q000523:psychology*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D010102:Oxygen Inhalation Therapy / Q000523:psychology / Q000706:statistics & numerical data*; D010349:Patient Compliance / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data; D011446:Prospective Studies; D016896:Treatment Outcome