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Use of simple clinical parameters to assess severity of bronchiolitis
T V Mai1, A M Selby, J M Simpson
1Department of Immunology and Infectious Diseases, Royal Alexandra Hospital for Children, Camperdown, New South Wales, Australia.
Insights
Simple clinical signs like intercostal recession and sternal retraction can help predict oxygen needs in infants with acute bronchiolitis. These findings are crucial for resource-limited settings where oxygen is scarce.
Area of Science:
- Pediatrics
- Respiratory Medicine
- Clinical Prediction
Background:
- Acute bronchiolitis is a common respiratory infection in infants.
- Predicting the need for supplemental oxygen is vital for effective management.
Purpose of the Study:
- To assess if simple clinical parameters can predict acute bronchiolitis severity.
- To determine the need for supplemental oxygen therapy in infants.
Main Methods:
- Prospective study of 71 infants under 15 months with acute bronchiolitis.
- Clinical parameters including respiratory rate, heart rate, and signs of respiratory distress were recorded.
- Outcome measured was the need for supplemental oxygen.
Main Results:
- 56% of infants required supplemental oxygen.
- Intercostal recession and sternal retraction moderately predicted oxygen need.
- Cyanosis on admission was rare but indicated a high likelihood of oxygen requirement.
Conclusions:
- Simple clinical signs show potential in predicting oxygen therapy needs in acute bronchiolitis.
- Further research is needed to establish definitive clinical criteria.
- Developing such criteria is critical for managing oxygen resources in developing countries.
Objective:
To determine whether simple clinical parameters could be used to predict the severity of acute bronchiolitis and the need for supplemental oxygen therapy.
Methodology:
A prospective study, performed in a tertiary care paediatric hospital. Seventy-one infants under 15 months of age with a clinical diagnosis of acute bronchiolitis were examined on admission. Clinical parameters were recorded, and each infant was re-examined after approximately 12 and 24 h. All infants were examined by one medical student and, when possible, by a doctor, the two being unaware of each other's findings. Parameters recorded included respiratory and heart rates and presence of wheeze, crackles, intercostal recession, sternal retraction and/or cyanosis. The outcome measure was the need for supplemental oxygen, as determined by the independent caring medical team, on the basis of pulse oximetry and clinical judgement.
Results:
Forty (56%) of the 71 babies required supplemental oxygen. All cyanosed babies required supplemental oxygen, but only 9 (21%) were cyanosed on admission. Intercostal recession (relative risk RR 2.55; 95% CI 1.28, 5.08) and sternal retraction (RR 1.60; 95% CI 1.06, 2.42) predicted the need for supplemental oxygen with moderate accuracy. Interobserver agreement was only fair for most parameters, but was poor for intercostal recession and good for cyanosis.
Conclusions:
Simple clinical parameters may help predict the need for oxygen therapy in acute bronchiolitis, although further studies are required to define suitable clinical criteria. Such criteria are extremely important in developing countries where oxygen is a scarce resource.