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Outpatient assessment of infants with bronchiolitis
K N Shaw1, L M Bell, N H Sherman
1Division of General Pediatrics, Children's Hospital of Philadelphia, PA 19104.
Insights
Predicting severe bronchiolitis in infants is possible using early emergency department clues. Key indicators include toxic appearance, low oxygen saturation, prematurity, rapid breathing, atelectasis, and young age, with oxygen saturation being the best predictor.
Area of Science:
- Pediatrics
- Infectious Diseases
- Respiratory Medicine
Background:
- Bronchiolitis is a common viral respiratory infection in infants.
- Predicting disease severity is crucial for timely intervention and resource allocation.
Purpose of the Study:
- To identify early clinical and laboratory predictors of severe bronchiolitis in infants.
- To compare initial emergency department findings between mild and severe cases.
Main Methods:
- Prospective follow-up of 213 infants (<13 months) diagnosed with bronchiolitis.
- Classification of disease severity (mild vs. severe) based on the overall illness course.
- Comparison of initial emergency department evaluation findings between severity groups.
Main Results:
- Six predictors of severe illness identified: "ill" appearance, oxygen saturation <95%, gestational age <34 weeks, respiratory rate ≥70/min, atelectasis on chest X-ray, and age <3 months.
- Oxygen saturation by pulse oximetry was the strongest single objective predictor of severe disease.
Conclusions:
- Early identification of infants at risk for severe bronchiolitis is feasible using specific emergency department findings.
- Oxygen saturation is a highly reliable objective marker for predicting severe outcomes in infants with bronchiolitis.
Abstract:
Two hundred thirteen infants younger than 13 months with bronchiolitis were prospectively followed up to identify the historical, physical, and laboratory clues at initial emergency department evaluation that would help to predict disease severity. Based on their total course of illness, the patients were classified as having mild (139 patients) or severe (74 patients) disease, and the initial emergency department evaluation findings of these two groups were compared. Six independent clinical and laboratory findings were identified that were strongly associated with more severe illness: (1) "ill" or "toxic" general appearance; (2) oxygen saturation less than 95%, as determined by pulse oximetry; (3) gestational age, younger than 34 weeks; (4) respiratory rate, 70/min or greater; (5) atelectasis on a chest roentgenogram; and (6) age, younger than 3 months. The infant's oxygen saturation as determined by pulse oximetry was the single best objective predictor of more severe disease.