Factors Associated With Longer Emergency Department Length of Stay for Children With Bronchiolitis

Mansbach, Jonathan M.; Clark, Sunday; Barcega, Besh; Haddad, Haitham; Camargo, Carlos A.

doi:10.1097/pec.0b013e3181b920e1

Cited by 14 publications

(16 citation statements)

References 30 publications

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“…15,20 However, clinical severity is only 1 factor involving the decision to hospitalize a child with bronchiolitis. Other factors include social, geographic, and cultural considerations.…”

Section: Discussionmentioning

confidence: 99%

Predicting Escalated Care in Infants With Bronchiolitis

Freire¹,

Kuppermann

Zemek

et al. 2018

Pediatrics

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BACKGROUND AND OBJECTIVES:Early risk stratification of infants with bronchiolitis receiving airway support is critical for focusing appropriate therapies, yet the tools to risk categorize this subpopulation do not exist. Our objective was to identify predictors of "escalated care" in bronchiolitis. We hypothesized there would be a significant association between escalated care and predictors in the emergency department. We subsequently developed a risk score for escalated care. METHODS:We conducted a retrospective cohort study of previously healthy infants aged <12 months with bronchiolitis. Our primary outcome was escalated care (ie, hospitalization with high-flow nasal cannula, noninvasive or invasive ventilation, or intensive care admission). The predictors evaluated were age, prematurity, day of illness, poor feeding, dehydration, apnea, nasal flaring and/or grunting, respiratory rate, oxygen saturation, and retractions. . One of 217 (0.5%) infants without predictors received escalated care. The risk score ranged from 0 to 14 points, with the estimated risk of escalated care from 0.46% (0 points) to 96.9% (14 points). The area under the curve was 85%. CONCLUSIONS:We identified variables measured in the emergency department predictive of escalated care in bronchiolitis and derived a risk score to stratify risk of this outcome. This score may be used to aid management and disposition decisions.

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“…15,20 However, clinical severity is only 1 factor involving the decision to hospitalize a child with bronchiolitis. Other factors include social, geographic, and cultural considerations.…”

Section: Discussionmentioning

confidence: 99%

Predicting Escalated Care in Infants With Bronchiolitis

Freire¹,

Kuppermann

Zemek

et al. 2018

Pediatrics

View full text Add to dashboard Cite

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“…Janahi et al 28 in a retrospective cohort study examined an inpatient population of 369 infants admitted with acute bronchiolitis in a hospital in Qatar, and found that retraction was an independent predictor of longer LOS. Finally, Mansbach et al 33 identified decreasing lowest oxygen saturation in the ED as a variable independently associated with ED LOS. However, although initial oxygen saturation could reflect a greater severity of the acute bronchiolitis episode, along with the subsequent prolonged LOS, the fact that hospitalizations of some infants with bronchiolitis are prolonged due to a perceived need for supplemental oxygen therapy based only on arbitrary thresholds of pulse oximetry readings has received increasing attention in studies and practice guidelines 34.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Prolonged Length of Hospital Stay for Infants with Bronchiolitis

Rodríguez‐Martínez¹,

Sossa-Briceño

Niño

2018

Journal of Investigative Medicine

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Among inpatients suffering from bronchiolitis, approximately a quarter may undergo a prolonged length of stay (LOS) for the treatment of their respiratory condition. However, there have been few research studies that have evaluated variables that may be associated with a prolonged LOS in these patients, especially in low-income and middle-income countries, where the clinical and economic burden of the disease is the greatest. In an analytical single-center cross-sectional study, we included a population of patients with acute bronchiolitis hospitalized between March and June 2016. We collected demographic and clinical information and the LOS of each patient. Prolonged LOS for bronchiolitis was defined as at least one hospital stay of 5 or more days. A total of 303 patients were included, with 176 (58.1%) male and a median (IQR) age of 3.0 (1.0-7.0) months. After controlling for gender, history of bronchopulmonary dysplasia, number of days with respiratory symptoms, the presence of apnea as an initial manifestation of bronchiolitis, and other underlying disease conditions, we found that the independent predictors of prolonged LOS for bronchiolitis in our study population included age (OR 0.92; 95% CI 0.84 to 0.99; p=0.049), history of prematurity (OR 6.34; 95% CI 1.10 to 36.46; p=0.038), respiratory syncytial virus isolation (OR 1.92; 95% CI 1.02 to 3.73; p=0.048), and initial oxygen saturation (OR 0.94; 95% CI 0.88 to 0.98; p=0.048). The factors identified should be taken into account when planning policies to reduce the duration of hospital stay in infants with bronchiolitis.

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“…[6][7][8] Wide variations in emergency department (ED) practice have been demonstrated using clinical quality metrics or resource utilization indicators. [9][10][11] Similarly, variability in admission, discharge decisions, and therapy have contributed to variability in the rate of admission and length of stay. 12 Isolated efforts at minimizing variation in these settings have demonstrated decreases in inpatient treatment variation and improved outcomes for bronchiolitis.…”

Section: Abstract: Bronchiolitis; Intraclass Correlation Coefficient;mentioning

confidence: 98%