Factors Predictive of Escalated Care in Infant Bronchiolitis ID'd

Include oxygen saturation < 90%, nasal flaring/grunting, apnea, retractions, age ≤2 months.
Include oxygen saturation < 90%, nasal flaring/grunting, apnea, retractions, age ≤2 months.

HealthDay News — Variables have been identified that predict escalated care for infants with bronchiolitis, according to a study published in the September issue of Pediatrics.

Gabrielle Freire, MD, from the University of Toronto, and colleagues conducted a retrospective cohort study of previously healthy infants aged <12 months with bronchiolitis to identify predictors of escalated care. The primary outcome of escalated care included hospitalization with high-flow nasal cannula, noninvasive or invasive ventilation, or admission to intensive care. 

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The researchers found that 9.6% of the 2722 patients received escalated care. Multivariable predictors included oxygen saturation <90%, nasal flaring and/or grunting, apnea, retractions, age ≤2 months, dehydration, and poor feeding (odds ratios, 8.9, 3.8, 3.0, 3.0, 2.1, 2.1, and 1.9, respectively). Only 0.5% of infants without predictors received escalated care. The risk score varied from 0 to 14 points, with the corresponding estimated risk of escalated care varying from 0.46 to 96.9%, and an area under the curve of 85%.

"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," the authors write. "This score may be used to aid management and disposition decisions."

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