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Really Scary? Predicting Bad Outcomes in Bronchiolitis

October 31, 2018

Written by Vivian Lei

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Specific emergency department variables are strongly predictive of infants with bronchiolitis requiring escalated care.

Why does this matter?
Bronchiolitis is a common reason for ED visits and hospitalization in infants. ED predictors of escalated care would be helpful for emergency physicians as well as pediatricians evaluating infants with bronchiolitis. Which babies should we not send home? Which ones likely need ICU care?

Hypoxic, grunting, dehydrated babies are a risky bunch
In this study, researchers performed a secondary analysis of retrospective data from the international Pediatric Emergency Research Network. Infants less than 12 months of age with a diagnosis of bronchiolitis were included in the study for a total of 2722 infants. Of these, 261 (9.6%) infants required escalated care, defined as need for hospitalization and need for any of the following: high-flow nasal cannula (HFNC), noninvasive ventilation support, tracheal intubation and ventilation, or management in an ICU setting without airway support. Multivariable analysis showed that the predictors that correlated most with escalated care needs were oxygen saturation <90% (OR 8.92), nasal flaring and/or grunting (OR 3.76), retractions (OR 3.02), apnea (OR 3.01), dehydration (OR 2.13), age under 2 months (OR 2.10), and poor feeding (OR 1.85). A risk score was derived from these factors that varied from 0 to 14 points. This corresponded with an estimated risk for escalated care of 0.9% for a score of 0 to 96.3% for a score of 14. While awareness of these risk factors may help in management and disposition decisions, the clinical utility of this risk score remains untested. Knowing these predictors makes bronchiolitis less SCARY.

Which babies with bronchiolitis NOT to send home:

  • Saturation <90%

  • Can’t take PO

  • Apnea

  • Retracting/flaring/grunting

  • Younger than 2 months

Predicting Escalated Care in Infants With Bronchiolitis. Pediatrics. 2018 Sep;142(3). pii: e20174253. doi: 10.1542/peds.2017-4253. Epub 2018 Aug 20.

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Reviewed (and SCARY) by Clay Smith

What are your thoughts?