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Published on: January 16, 2019
Prospective multicenter bronchiolitis study: predicting intensive care unit admissions
Dorothy Damore1, Jonathan M Mansbach, Sunday Clark
1Department of Emergency Medicine, New York Presbyterian Hospital/Weill Cornell Medial Center, New York, NY, USA. djt2001@med.cornell.edu
Insights
Young children with bronchiolitis are more likely to need intensive care unit (ICU) admission if they are under two months old, recently visited the emergency department, have severe breathing difficulty, or poor oral intake. These factors predict ICU admission in pediatric patients.
Area of Science:
- Pediatrics
- Critical Care Medicine
- Epidemiology
Background:
- Bronchiolitis is a common respiratory infection in infants and young children.
- Predicting intensive care unit (ICU) admission is crucial for resource allocation and timely intervention.
Purpose of the Study:
- To identify predictors of ICU admission in children hospitalized with bronchiolitis.
Main Methods:
- Prospective cohort study conducted in 30 U.S. emergency departments over two bronchiolitis seasons (2004-2006).
- Included patients were under 2 years old with a confirmed diagnosis of bronchiolitis.
- Compared characteristics of patients admitted to regular floor versus ICU.
Main Results:
- Of 1,456 enrolled patients, 3% were admitted to the ICU.
- Key predictors for ICU admission included age <2 months (OR=4.1), recent ED visit (OR=2.2), moderate/severe retractions (OR=2.6), and inadequate oral intake (OR=3.3).
- No association found with male gender, socioeconomic factors, insurance status, breastfeeding, or parental asthma.
Conclusions:
- Four independent predictors of ICU admission for bronchiolitis were identified in this multicenter study.
- Several previously suggested risk factors were not confirmed as significant predictors.
- Modest associations with other factors cannot be entirely ruled out.
Objectives:
The authors sought to identify predictors of intensive care unit (ICU) admission among children hospitalized with bronchiolitis for > or =24 hours.
Methods:
The authors conducted a prospective cohort study during two consecutive bronchiolitis seasons, 2004 through 2006, in 30 U.S. emergency departments (EDs). All included patients were aged <2 years and had a final diagnosis of bronchiolitis. Regular floor versus ICU admissions were compared.
Results:
Of 1,456 enrolled patients, 533 (37%) were admitted to the regular floor and 50 (3%) to the ICU. Comparing floor and ICU admissions, multivariate ED predictors of ICU admission were age <2 months (26% vs. 53%; odds ratio [OR] = 4.1; 95% confidence interval [CI] = 2.1 to 8.3), an ED visit the past week (25% vs. 40%; OR = 2.2; 95% CI = 1.1 to 4.4), moderate/severe retractions (31% vs. 48%; OR = 2.6; 95% CI = 1.3 to 5.2), and inadequate oral intake (31% vs. 53%; OR = 3.3; 95% CI = 1.6 to 7.1). Unlike previous studies, no association with male gender, socioeconomic factors, insurance status, breast-feeding, or parental asthma was found with ICU admission.
Conclusions:
In this prospective multicenter ED-based study of children admitted for bronchiolitis, four independent predictors of ICU admission were identified. The authors did not confirm many putative risk factors, but cannot rule out modest associations.
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