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A randomized trial of home oxygen therapy from the emergency department for acute bronchiolitis
Lalit Bajaj1, Carol G Turner, Joan Bothner
1Department of Pediatrics, University of Colorado Health Sciences Center/Children's Hospital, Denver, CO 80218, USA. bajaj.lalit@tchden.org
Insights
Discharging infants with bronchiolitis on home oxygen from the emergency department is feasible and safe. Most children successfully completed treatment at home, with a low rate of readmission, indicating a promising approach for acute bronchiolitis management.
Area of Science:
- Pediatrics
- Emergency Medicine
- Pulmonology
Background:
- Hypoxia is a frequent cause for hospitalization in pediatric acute bronchiolitis.
- No prior studies have assessed the safety and feasibility of discharging patients home on oxygen from the emergency department (ED).
Purpose of the Study:
- To evaluate the feasibility and safety of discharging infants and children with acute bronchiolitis on home oxygen from the ED.
Main Methods:
- A prospective, randomized trial involving 92 infants and children (2-24 months) with acute bronchiolitis and hypoxia (SpO2 ≤87%).
- Participants were randomized to either inpatient admission or home oxygen after an 8-hour ED observation period.
- Outcomes measured included failure to meet discharge criteria, hospital readmission rates, and serious complications.
Main Results:
- 37 out of 53 (70%) patients randomized to home oxygen were successfully discharged from the ED.
- Only one discharged patient (2.7%) required hospital admission for a home cyanotic spell.
- The majority of patients (97%) treated with home oxygen had successful outpatient management, with high caregiver and provider satisfaction.
Conclusions:
- Emergency department discharge on home oxygen is a viable option for select pediatric patients with acute bronchiolitis after observation.
- The low complication rate suggests safety, but a larger study is needed to confirm the practice's overall safety profile.
Objective:
Hypoxia is a common reason for hospital admission in infants and children with acute bronchiolitis. No study has evaluated discharge from the emergency department (ED) on home oxygen. This study evaluated the feasibility and safety of ED discharge on home oxygen in the treatment of acute bronchiolitis.
Methods:
This was a prospective, randomized trial of infants and children with acute bronchiolitis and hypoxia (room-air saturations of < or =87%) aged 2 to 24 months presenting to an urban, academic, tertiary care children's hospital ED from December 1998 to April 2001. Subjects received inpatient admission or home oxygen after an 8-hour observation period in the ED. We measured the failure to meet discharge criteria during the observation period, return for hospital admission, and incidence of serious complications.
Results:
Ninety-two patients were enrolled. Fifty three (58%) were randomly assigned to home and 39 (42%) to inpatient admission. There were no differences between the groups in age, initial room-air saturation, and respiratory distress severity score. Of 53 patients, 37 (70%) randomly assigned to home oxygen completed the observation period and were discharged from the hospital. The remaining 16 patients were excluded from the study (6), resolved their oxygen requirement (5), or failed to meet the discharge criteria and were admitted (5). One discharged patient (2.7%) returned to the hospital and was admitted for a cyanotic spell at home after the 24-hour follow-up appointment. The patient had an uncomplicated hospital course with a length of stay of 45 hours. The remaining 36 patients (97%) were treated successfully as outpatients with home oxygen. Satisfaction with home oxygen was high from the caregiver and the primary care provider.
Conclusions:
Discharge from the ED on home oxygen after a period of observation is an option for patients with acute bronchiolitis. Secondary to the low incidence of complications, the safety of this practice will require a larger study.
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