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Predicting Escalated Care in Infants With Bronchiolitis.

Gabrielle Freire¹, Nathan Kuppermann², Roger Zemek³

¹Division of Pediatric Emergency Medicine, and.

|August 22, 2018

Summary

A new risk score helps predict escalated care in infants with bronchiolitis. This tool identifies infants needing hospitalization or intensive care, improving early management decisions.

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Point-of-Care Ultrasound: A Review of Ultrasound Parameters for Predicting Difficult Airways

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Area of Science:

Pediatrics
Respiratory Medicine
Emergency Medicine

Background:

Early risk stratification for infants with bronchiolitis requiring airway support is crucial for effective therapy.
Existing tools for risk categorizing this vulnerable population are lacking.
Bronchiolitis is a common respiratory infection in infants, often necessitating medical intervention.

Purpose of the Study:

To identify predictors of escalated care in infants diagnosed with bronchiolitis.
To develop a risk score for predicting the need for escalated care in this patient group.
To enhance the ability to focus appropriate therapies by identifying high-risk infants.

Main Methods:

A retrospective cohort study was conducted on infants under 12 months with bronchiolitis.
Escalated care, defined as hospitalization with advanced respiratory support or ICU admission, was the primary outcome.
Predictors evaluated included clinical signs, vital signs, and feeding status in the emergency department.

Main Results:

Nearly 10% of 2722 infants received escalated care.
Key predictors identified were low oxygen saturation, nasal flaring/grunting, apnea, retractions, young age (≤2 months), dehydration, and poor feeding.
A derived risk score demonstrated strong predictive accuracy (AUC 85%), with risk ranging from 0.46% to 96.9% based on score.

Conclusions:

Variables measurable in the emergency department can predict escalated care in bronchiolitis.
A novel risk score was developed to stratify the risk of escalated care.
This risk score can assist in clinical management and disposition decisions for infants with bronchiolitis.