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Risk factors for admission in children with bronchiolitis from pediatric emergency department observation unit
Shabana Yusuf1, A Chantal Caviness, Aderonke O Adekunle-Ojo
1Department of Pediatrics, Texas Children's Hospital, Houston, TX 77030, USA. syusuf@bcm.edu
Insights
Infants with bronchiolitis requiring emergency department observation unit care may need hospitalization. Predictors for admission include poor feeding, increased work of breathing, low oxygen saturation, and specific emergency department treatments.
Area of Science:
- Pediatrics
- Emergency Medicine
- Respiratory Illness
Background:
- Bronchiolitis admissions to observation units are rising.
- Many patients require subsequent hospitalization.
- Identifying predictors for direct hospital admission is crucial.
Purpose of the Study:
- Determine predictors of hospital admission from observation units for bronchiolitis patients.
- Identify key factors influencing disposition decisions.
Main Methods:
- Retrospective cohort study.
- Patients under 2 years with bronchiolitis admitted to an EDOU (Emergency Department Observation Unit).
- Logistic regression analysis to identify predictors.
Main Results:
- 26% of 325 patients were admitted to the hospital.
- Predictors included poor feeding, increased work of breathing, oxygen saturation <93%, racemic epinephrine, and IV fluids.
- Younger infants (<6 months) and males were common.
Conclusions:
- Increased work of breathing, oxygen saturation <93%, and IV fluid treatment predict hospital admission.
- Consider direct hospital admission for these high-risk patients.
- Early identification can optimize care pathways.
Background:
Patients with bronchiolitis are increasingly being admitted to emergency department observation units (EDOUs) but often require subsequent hospitalization. To better identify ED patients who should be directly admitted to the hospital rather than the EDOU, the predictors of admission must be identified.
Objectives:
The objective of this study was to determine the predictors of subsequent hospital admission from the EDOU in infants and young children with bronchiolitis.
Method:
This was a retrospective cohort study of patients younger than 2 years admitted to an EDOU with bronchiolitis between April 1, 2003, and March 31, 2007. Univariate analysis was followed by logistic regression to identify the significant predictors of hospital admission from the EDOU.
Results:
There were 325 patients in the study: 67% were younger than 6 months, and 60% were male. Eighty-five (26%) were admitted to the hospital from the EDOU. Predictors for admission from the EDOU included parental report of poor feeding or increased work of breathing, oxygen saturation less than 93%, or ED treatment with racemic epinephrine (Vaponephrine) and intravenous fluids (IVFs).
Conclusion:
Patients with a history of increased work of breathing or oxygen saturation less than 93% and ED treatment with IVFs are at high risk for admission from the EDOU to the hospital. Direct admission to the hospital from the ED should be considered for these patients, particularly patients treated with IVFs and having an oxygen saturation less than 93% in the ED.
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