Infant bronchiolitis in the ED: risk score predicts care escalation

  • Freire G & al.
  • Pediatrics
  • 20 Aug 2018

  • curated by Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • Low oxygen saturation, nasal flaring, and retractions are among several strong predictors of admission plus airway support among infants with bronchiolitis in emergency department (ED).
  • Prospective validation of risk score is needed.

Why this matters

  • Early ED risk stratification is difficult in this population.
  • Previous studies of infant bronchiolitis did not focus on ED.

Key results

  • 261 (9.6%) infants received escalated care.
  • On multivariate analysis, significant predictors of escalated care were:
    • Oxygen saturation upon triage  
    • Nasal flaring and/or grunting (OR, 3.76; P<.0001>
    • Retractions (OR, 3.02; P=.0007);
    • Apnea (OR, 3.01; P<.0001>
    • Dehydration (OR, 2.13; P=.0007); 
    • Age ≤2 months (OR, 2.10; P<.0001>
    • Poor feeding (OR, 1.85; P=.0015).
  • 1 infant without predictors received care escalation.
  • Symptom duration did not predict escalation.
  • Area under the curve for derived risk score was 84.7% (95% CI, 81.7%-86.8%).

Study design

  • Planned secondary analysis of retrospective multinational cohort study through Pediatric Emergency Research Networks.
  • Participants were 2722 infants aged  
  • Primary outcome: escalated care, defined as hospitalization plus high-flow nasal cannula, noninvasive or invasive ventilation, or intensive care.
  • Funding: None. 

Limitations

  • Some present variables may have gone undocumented in chart.
  • Infants with comorbidities excluded.

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