Hostname: page-component-586b7cd67f-2brh9 Total loading time: 0 Render date: 2024-11-28T05:34:44.676Z Has data issue: false hasContentIssue false
  • English
  • Français

Bronchiolitis: Can objective criteria predict eligibility for brief hospitalization?

Published online by Cambridge University Press:  21 May 2015

Lance Brown ,
David G. Reiley ,
Aaron Jeng  and
Steven M. Green
Lance Brown*
Affiliation:
Loma Linda University Medical Center and Children’s Hospital, Loma Linda, Calif.
David G. Reiley
Affiliation:
Loma Linda University Medical Center and Children’s Hospital, Loma Linda, Calif.
Aaron Jeng
Affiliation:
Loma Linda University School of Allied Health Sciences, Loma Linda, Calif.
Steven M. Green
Affiliation:
Loma Linda University Medical Center and Children’s Hospital, Loma Linda, Calif.
*
Department of Emergency Medicine, A-108 Loma Linda University Medical Center and Children’s Hospital, 11234 Anderson St., Loma Linda CA 92354; 909 558-4344, fax 909 558-0121, [email protected]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objective:

To determine if 3 objective criteria – pulse oximetry, respiratory syncytial virus (RSV) testing, and age – could be used to predict which children hospitalized with bronchiolitis will have brief (<36 hour) hospitalizations and therefore be potential candidates for admission to short-stay observation units.

Methods:

This was a retrospective medical record review of medically uncomplicated children 3 to 24 months of age with emergency department and hospital discharge diagnoses consistent with bronchiolitis who were admitted to a general pediatric ward in our university-based, tertiary care hospital between Jan. 1, 1992, and Nov. 12, 2002. Multiple logistic regression was used to assess the predictor variables.

Results:

Our study consisted of 225 patients (45% female) with a median age of 7 months (interquartile range [IQR], 4–11 mo; range, 3–22 mo). Median pulse oximetry value was 94% (IQR 91%–96%; range 76%–100%), and 71% of the patients tested positive for RSV. Thirty children (13%) had brief hospitalizations <36 hours, and the median hospital length of stay for the entire study group was 70 hours (IQR 46–108 h; range 6–428 h). None of the 3 predictor variables were independently associated with brief hospitalization.

Conclusions:

Pulse oximetry, RSV testing and age do not predict which children will have brief hospitalizations and are appropriate candidates for admission to short-stay observation units.

Keywords

pulse oximetryrespiratory syncytial virusobservation unit
Type
Pediatric EM • Pédiatrie d’urgence
Information
Canadian Journal of Emergency Medicine , Volume 5 , Issue 4 , July 2003 , pp. 239 - 244
Copyright
Copyright © Canadian Association of Emergency Physicians 2003

References

1.Langley, JM, Wang, EE, Law, BJ, Stephens, D, Boucher, FD, Dobson, S, et al. Economic evaluation of respiratory syncytial virus infection in Canadian children: a Pediatric Investigators Collaborative Network on Infections in Canada (PICNIC) study. J Pediatr 1997;131:113–7.CrossRefGoogle ScholarPubMed
2.Howard, TS, Hoffman, LH, Stang, PE, Simoes, EAF.Respiratory syncytial virus pneumonia in the hospital setting: length of stay, charges, and mortality. J Pediatr 2000;137:227–32.CrossRefGoogle ScholarPubMed
3.Shay, DK, Holman, RC, Newman, RD, Liu, LL, Stout, JW, Anderson, LJ.Bronchiolitis-associated hospitalizations among US children, 1980–1996. JAMA 1999;282:1440–6.CrossRefGoogle ScholarPubMed
4.Mallory, MD, Shay, DK, Garrett, J, Bordley, WC.Bronchiolitis management preferences and the influence of pulse oximetry and respiratory rate on the decision to admit. Pediatrics [Internet] 2003;111:e45–51. Available: www.pediatrics.org/cgi/content/full/111/1/e45 (accessed 2003 May 8).CrossRefGoogle Scholar
5.Brown, L, Dannenberg, B.Pulse oximetry in discharge decision-making: a survey of emergency physicians. Can J Emerg Med 2002;4(6):388–93.CrossRefGoogle ScholarPubMed
6.Johnson, DW, Adair, C, Brant, R, Holmwood, J, Mitchell, I.Differences in admission rates of children with bronchiolitis by pediatric and general emergency departments. Pediatrics [Internet] 2002;110:e49. Available: www.pediatrics.org/cgi/content/full/110/4/e49 (accessed 2003 May 8).CrossRefGoogle Scholar
7.Willson, DF, Horn, SD, Hendley, O, Smout, R, Gassaway, J.Effect of practice variation on resource utilization in infants hospitalized for viral lower respiratory illnesses. Pediatrics 2001;108:851–5.CrossRefGoogle Scholar
8.Green, M, Brayer, AF, Schenkman, KA, Wald, ER.Duration of hospitalizatiton in previously well infants with respiratory syncytial virus infection. Pediatr Infect Dis J 1989;8:601–5.Google Scholar
9.Kini, NM, Robbins, JM, Kirschbaum, MS, Frisbee, SJ, Kotagal, UR.Inpatient care for uncomplicated bronchiolitis: comparison with Milliman and Robertson guidelines. Arch Pediatr Adolesc Med 2001;155(12):1323–7.CrossRefGoogle ScholarPubMed
10.Boyce, TG, Mellen, BG, Mitchel, EF, Wright, PF, Griffin, MR.Rates of hospitalization for respiratory syncytial virus infection among children in Medicaid. J Pediatr 2000;137:865–70.Google Scholar
11.Brooks, AM, McBride, JT, McConnochie, KM, Aviram, M, Long, C, Hall, CB.Predicting deterioration in previously healthy infants hospitalized with respiratory syncytial virus infection. Pediatrics 1999;104:463–7.CrossRefGoogle ScholarPubMed
12.Purcell, K, Fergie, J.Concurrent serious bacterial infections in 2396 infants and children hospitalized with respiratory syncytial virus lower respiratory tract infections. Arch Pediatr Adolesc Med 2002;156:322–4.CrossRefGoogle ScholarPubMed
13.Browne, GJ.A short stay or 23-hour ward in a general and academic children’s hospital: Are they effective? Pediatr Emerg Care 2000;16:223–9.CrossRefGoogle Scholar
14.Mace, SE.Pediatric observation medicine. Emerg Med Clin North Am 2001;19:239–54.Google Scholar
15.Perlstein, PH, Kotagal, UR, Bolling, C, Steele, R, Schoettker, PJ, Atherton, HD, et al. Evaluation of an evidence-based guideline for bronchiolitis. Pediatrics 1999;104:1334–41.CrossRefGoogle ScholarPubMed
16.Shaw, KN, Bell, LM, Sherman, NH.Outpatient assessment of infants with bronchiolitis. Am J Dis Child 1991;145:151–5.Google ScholarPubMed
17.Mulholland, EK, Olinsky, A, Shann, FA.Clinical findings and severity of acute bronchiolitis. Lancet 1990;335:1259–61.Google Scholar
18.Harrell, FE, Lee, KL, Matchar, DB, Reichert, TA.Regression models for prognostic prediction: advantages, problems, and suggested solutions. Cancer Treat Rep 1985;69:1071–7.Google ScholarPubMed
19.Fleiss, JL.Measuring nominal scale agreement among many raters. Psychol Bull 1971;76:378–82.CrossRefGoogle Scholar
20.Wang, EE, Law, BJ, Stephens, D.Pediatric Investigators Collaborative Network on Infections in Canada (PICNIC) prospective study of risk factors and outcomes in patients hospitalized with respiratory syncytial viral lower respiratory tract infection. J Pediatr 1995;126:212–9.CrossRefGoogle ScholarPubMed
21.Kneyber, MCJ, Moons, KGM, de Groot, R, Moll, HA.Prediction of duration of hospitalization in respiratory syncytial virus infection. Pediatr Pulmonol 2002;33:453–7.Google Scholar
22.McMillan, JA, Tristram, DA, Weiner, LB, Higgins, AP, Sandstrom, C, Brandon, R.Prediction of the duration of hospitalization in patients with respiratory syncytial virus infection: use of clinical parameters. Pediatrics 1988;81:22–6.CrossRefGoogle ScholarPubMed
23.Moler, FW, Ohmit, SE.Severity of illness models for respiratory syncytial virus-associated hospitalization. Am J Respir Crit Care Med 1999;159:1234–40.Google Scholar
24.Schuh, S, Coates, AL, Binnie, R, Allin, T, Goia, C, Corey, M, et al. Efficacy of oral dexamethasone in outpatients with acute bronchiolitis. J Pediatr 2002;140:27–32.Google Scholar
25.Schibanoff, JM, editor. Pediatric health status improvement and management. Seattle (WA): Milliman & Robertson Inc; 1999.Google Scholar