Safely Discharging Infants with Bronchiolitis from an Emergency Department: A Five Step Guide for Pediatricians

Area of Science:

• Pediatrics
• Emergency Medicine
• Respiratory Illness

Background:

• Established pulse oxygen saturation (SpO2) thresholds exist for bronchiolitis hospitalization and discharge.
• Clear guidelines are lacking for Emergency Department (ED) observation periods for infants with SpO2 ≥ 90%-92%.

Purpose of the Study:

• Evaluate risk factors for delayed desaturation in infants with SpO2 ≥ 92% on ED arrival.
• Determine optimal ED observation duration for safe home discharge.
• Identify risk factors for ED readmission.

Main Methods:

• Retrospective analysis of 581 infant bronchiolitis ED episodes.
• Analysis of SpO2 levels, clinical presentation, and patient demographics.
• Identification of risk factors using logistic regression (Odds Ratios provided).

Main Results:

• 18% of infants experienced delayed desaturation (<92%) during ED observation.
• Risk factors for delayed desaturation included female sex, age <3 months, prior ED readmission, severe presentation, and elevated pCO2.
• Delayed desaturation occurred within 25 hours for infants <3 months and 11 hours for those ≥3 months.

Conclusions:

• A five-step guide and age-specific ED observation periods (11 hours for ≥3 months, 25 hours for <3 months) can identify 95% of infants at risk of delayed desaturation.
• These guidelines aid pediatricians in safe ED discharge decisions for infants with bronchiolitis.