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Effects of implementing a clinical scoring system on the management of infants with RSV bronchiolitis
K Konzett1, C Polzer2, A Wippel2
1Department of Pediatrics and Adolescent Medicine, Academic Teaching Hospital Feldkirch, Feldkirch, Austria. karin.konzett@lkhf.at.
Insights
Implementing a clinical pathway for respiratory syncytial virus (RSV) bronchiolitis in infants did not significantly change hospital length of stay but proved to be a safe tool for preventing readmissions.
Area of Science:
- Pediatrics
- Infectious Diseases
- Clinical Medicine
Background:
- Respiratory syncytial virus (RSV) is a leading cause of infant lower respiratory tract infections and hospitalizations.
- Existing severity assessment scores for RSV bronchiolitis lack robust validation.
- The Children's Hospital of Philadelphia (CHOP) developed a clinical pathway for bronchiolitis management.
Purpose of the Study:
- To implement and evaluate a standardized bronchiolitis scoring system and clinical pathway based on the CHOP model.
- To assess the impact of the pathway on infant length of stay.
- To determine the risk of readmission after implementing the new pathway.
Main Methods:
- A retrospective analysis of 261 infants (1 month to 1 year) diagnosed with RSV acute bronchiolitis over 9 years.
- Data collected from 5 years pre-implementation (2014-2019) and 4 years post-implementation (2020-2024).
- Comparison of length of stay and readmission rates between the two groups.
Main Results:
- No significant difference in age or sex distribution between pre- and post-implementation groups.
- Average length of stay showed a non-significant decrease of 0.4 days post-implementation (5.6 vs. 5.3 days).
- Overall readmission rate was low (1.7%), with a non-significant decrease post-implementation (2.8% vs. 0.8%).
Conclusions:
- The implemented structured clinical pathway provides effective guidance for bronchiolitis management.
- The pathway did not significantly alter the length of hospital stay for infants with RSV bronchiolitis.
- The scoring system and pathway are safe and effective in minimizing readmission rates.
Introduction:
Respiratory syncytial virus (RSV) is a common pathogen of lower respiratory tract infections in infants 1 month to 1 year of age. Infections with RSV are the most common cause for hospitalization for respiratory infections and present with a high rate of complications. Different scores for severity assessment currently exist but only few of them are well validated. The "Inpatient clinical pathway for evaluation/treatment of children with bronchiolitis" from the Children's Hospital of Philadelphia (CHOP) provides clear and concise guidance for severity grading and inpatient management.
Aim:
In 2019 we implemented a bronchiolitis scoring system and pathway in accordance with the CHOP pathway in our inpatient setting to assess and monitor children affected by bronchiolitis as well as to plan their discharge. This study investigated the length of stay before and after implementation of the score and the risk of readmission after regular discharge.
Methods:
Data from all admitted infants 1 month to 1 year of age with a discharge diagnosis of acute bronchiolitis due to RSV (ICD 10-GM 2024 J21.0, n = 261) over a period of 9 years were evaluated, 5 winters (2014-2019, n = 140) before (group 1) and 4 winters (2020-2024, n = 121) after (group 2) implementation of the score.
Results:
The study population did not differ before and after implementation of the score with respect to age (group 1: mean age = 99.9 ± 87.3 days vs. group 2: 120.2 ± 85.6 days) and sex. The groups were equally sized with a mean of 28-30 patients per season. The average length of stay was 5.5 ± 3.4 SD days. Although the length of stay before and after implementation decreased on average by 0.4 days the result was not significant (5.6 ± 3.8 SD vs. 5.3 ± 2.8 SD days, p = 0.2). The readmission rate in total was very low (5/261, 1.7%) and only 1 patient had to be readmitted after implementation of the score (4/140, 2.8% vs. 1/121, 0.8%, p = 0.38).
Conclusion:
This structured clinical bronchiolitis pathway provides concise advice for outpatient as well as inpatient management. The length of stay did not differ before and after implementation. The score is a safe and useful tool for preventing readmission.
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