Prospective Multicenter Study of Bronchiolitis: Predicting Safe Discharges From the Emergency Department
ABSTRACT Bronchiolitis is the leading cause of hospitalization for infants. Our objective was to identify factors associated with safe discharge to home from the emergency department.
We conducted a prospective cohort study during 2 consecutive bronchiolitis seasons, from 2004 to 2006. Thirty US emergency departments contributed data. All patients were < 2 years of age and had a final emergency department attending physician diagnosis of bronchiolitis. Using multivariate logistic regression, a low-risk model was developed with a random half of the data and then validated with the other half.
Of 1456 enrolled patients, 837 (57%) were discharged home from the emergency department. The following factors predicted safe discharge to home: age of > or = 2 months, no history of intubation, a history of eczema, age-specific respiratory rates (< 45 breaths per minute for 0-1.9 months, < 43 breaths per minute for 2-5.9 months, and < 40 breaths per minute for 6-23.9 months), no/mild retractions, initial oxygen saturation of > or = 94%, fewer albuterol or epinephrine treatments in the first hour, and adequate oral intake. The importance of each factor varied slightly according to age, but the comprehensive model (developed and validated for all children < 2 years of age) yielded an area under the receiver operating characteristic curve of 0.81, with a good fit of the data.
This large multicenter study of children presenting to the emergency department with bronchiolitis identified several factors associated with safe discharge, including cut points for respiratory rate and oxygen saturation. Although the low-risk model requires further study, we believe that it will assist clinicians evaluating children with bronchiolitis and may help reduce some unnecessary hospitalizations.
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- "Several studies have focused on determining predictors of hospital - ization and length of stay ( LOS ) for children with bronchiolitis ( Corneli et al . , 2012 ; El Radhi , Barry , & Patel , 1999 ; Mansbach et al . , 2008 ; Marlais et al . , 2011 ; Norwood , Mansbach , Clark , Waseem , & Camargo , 2010 ; Parker et al . , 2009 ; Unger & Cunningham , 2008 ) . Oxygen therapy has been reported as a principal determinant of LOS for infants admitted to hospital with bronchiolitis ( Unger & Cunningham , 2008 ) . The most common barrier to discharge reported by "
ABSTRACT: Background: Acute lower respiratory tract infection (LRTI) including bronchiolitis, is one of the leading causes of pediatric hospital admissions worldwide. Recent studies have demonstrated that some children with acute bronchiolitis can be successfully managed using home oxygen therapy. Aim: To report the impact of a Hospital in The Home Oxygen therapy program (HiTHOx) for selected infants and young children with acute bronchiolitis and other LRTI. Findings: The HiTHOx program appears to be a safe model of care for carefully selected infants and young children with acute bronchiolitis and LRTI that reduces the hospital length of stay. Conclusions: The HiTHOx program provides an alternative model of care for infants and young children with acute LRTI. Implementation of models of care similar to that of the HiTHOx program in other pediatric health services may have the potential to create additional bed capacity, at the time of year when it is most needed.Issues in Comprehensive Pediatric Nursing 10/2013; 36(4). DOI:10.3109/01460862.2013.834397