Sepsis evaluations in hospitalized infants with bronchiolitis

To define variation in the decision to perform a sepsis evaluation in hospitalized infants with bronchiolitis, to define predictors of the decision and to measure the clinical and cost outcomes.

Retrospective chart review of all nonintensive care unit infants < or = 60 days with any discharge diagnosis of bronchiolitis (n = 282 from 1993 to 1995 in a 232-bed pediatric hospital. Process variables included temperature at sepsis work-up or Tmax if no sepsis workup. Outcome variables were charges, length of stay, sepsis workup and serious bacterial infection.

There was no difference in mean temperature between groups with or without sepsis evaluation (38.1 degrees C, P = 0.75). Of 282 infants 140 had a sepsis workup; 5 (1.8%) had serious bacterial infection. Infants with sepsis workup had an average total charge of $4507 and length of stay of 3.4 days compared with $2998 and 2.8 days for those without (P = 0.0001 and P = 0.002, respectively). A multivariate logistic regression model was constructed with sepsis workup as the dichotomous dependent variable. Significant (P < or = 0.05) predictor variables with a positive coefficient were: higher bronchiolitis score and normal chest roentgenogram. Significant variables with a negative coefficient were: admission diagnosis of bronchiolitis, chest roentgenogram typical for bronchiolitis and age > 28 days.

Temperature was not a predictor of sepsis evaluation. Infants with respiratory distress and normal chest roentgenogram were more likely to receive sepsis evaluations; those with recognized typical bronchiolitis and those > 28 days of age were less likely. Risk of serious bacterial infection is low; the costs of a sepsis evaluation outweigh the benefits in infants with obvious bronchiolitis.