Day of Illness and Outcomes in Bronchiolitis Hospitalizations

Abstract

BACKGROUND: Bronchiolitis is often described to follow an expected clinical trajectory, with a peak in severity between days 3 and 5. This predicted trajectory may influence anticipatory guidance and clinical decision-making. We aimed to determine the association between day of illness at admission and outcomes, including hospital length of stay, receipt of positivepressure ventilation, and total cough duration.METHODS: We compiled data from 2 multicenter prospective studies involving bronchiolitis hospitalizations in patients ,2 years. Patients were excluded for complex conditions. We assessed total cough duration via weekly postdischarge phone calls. We used mixed-effects multivariable regression models to test associations between day of illness and outcomes, with adjustment for age, sex, insurance (government versus nongovernment), race, and ethnicity. RESULTS:The median (interquartile range) day of illness at admission for 746 patients was 4 (2-5) days. Day of illness at admission was not associated with length of stay (coefficient 0.01 days, 95% confidence interval [CI]: 20.05 to 0.08 days), positive-pressure ventilation (adjusted odds ratio: 1.0, 95% CI: 0.9 to 1.1), or total cough duration (coefficient 0.33 days, 95% CI: 20.01 to 0.67 days). Additionally, there was no significant difference in day of illness at discharge in readmitted versus nonreadmitted patients (5.9 vs 6.4 days, P = .54). The median cough duration postdischarge was 6 days, with 65 (14.3%) patients experiencing cough for 141 days. CONCLUSIONS:We found no associations between day of illness at admission and outcomes in bronchiolitis hospitalizations. Practitioners should exercise caution when making clinical decisions or providing anticipatory guidance based on symptom duration.WHAT'S KNOWN ON THIS SUBJECT: Bronchiolitis has been described to follow an expected trajectory with a peak in illness severity between 3 and 5 days of illness. This anticipated trajectory may influence anticipatory guidance and clinical decision-making.WHAT THIS STUDY ADDS: Using data from 2 multicenter prospective studies, we demonstrate no association between day of illness and clinically important outcomes in bronchiolitis hospitalizations. Health care providers should be cautious about using day of illness to inform anticipatory guidance and decision-making.

Duration of monitoring after cessation of oxygen therapy in infants with bronchiolitis

“…1 It results in a high proportion of admissions to health-care systems in Australia and across the world, accounting for approximately 18% of paediatric hospitalizations in the United States. [2][3][4][5][6][7][8][9] Bronchiolitis is managed supportively with observation, feeding support and oxygen administration as required. 2 The World Health Organization (WHO) states that bronchiolitis and pneumonia are the leading causes of hypoxemia in children and recommend oxygen administration when saturations are ≤90%.…”

“…Bronchiolitis is the most common paediatric condition affecting the lower respiratory tract in the first year of life 1 . It results in a high proportion of admissions to health‐care systems in Australia and across the world, accounting for approximately 18% of paediatric hospitalizations in the United States 2–9 . Bronchiolitis is managed supportively with observation, feeding support and oxygen administration as required 2 …”

Bronchiolitis

“…5 5 Parents should be advised that cough may persist Although symptoms peak between 3 and 5 days from onset, there is no association between day of illness at admission and hospital length of stay. 6 Cough will usually resolve within 2 weeks, but about 10% of children may have persistent cough for 3 weeks or longer.…”

Bronchiolite

“…5 Il faut informer les parents que la toux peut persister Même si les symptômes connaissent un pic entre le 3 e et le 5 e jour suivant leur déclenchement, il n'y a pas de lien entre le nombre de jours écoulés avant l'admission et la durée du séjour hospitalier 6 . La toux rentrera habituellement dans l'ordre en 2 semaines, mais elle peut persister pendant 3 semaines ou plus chez près de 10 % des enfants.…”