Predictors of Major Intervention in Infants With Bronchiolitis

Objective: We sought to identify predictors of the major medical intervention (MMI) in infants with bronchiolitis in the Emergency Department (ED) to recognize those in need of hospitalization versus the candidates for discharge. Patients and Methods: We conducted an analysis of data from a prospective cohort study of previously healthy infants 2-23 months presenting to our ED with first episode of wheeze and respiratory distress. Infants were divided into those with at least one MMI defined as oxygen administration for saturation of <90%, intravenous (IV) fluids of 20 ml/kg, apnea management, or critical care unit (CCU) admission (MMI group) versus those without (no-MMI group). The primary outcome was the association between the MMI versus no-MMI groups and potential risk factors for these outcomes. Results: Of 312 study infants, 52 experienced MMI-all received oxygen for saturation <90%, four also received IV fluids and none required apnea management or CCU care. The following four risk factors were associated with MMI: baseline accessory muscle score >= 6/9 [OR 2.44, 95% CI 1.29; 4.62], oxygen saturation <= 92% [OR 2.41, 95% CI 0.96; 6.14], respiratory rate >= 60 [OR 1.85, 95% CI 0.97; 3.54], and poor fluid intake [OR 2.65, 95% CI 1.12; 6.26]. Of the 148 infants without predictors 11 (7.4%) received MMI, 145 required either no MMI or oxygen for <= 6 hr and 130 (87.8%) stayed for <= 12 hr. Conclusions: Infants with bronchiolitis with high-risk predictors should be hospitalized whereas those without can be considered for outpatient management due to low-risk of MMI. Pediatr Pulmonol. 2009;44:358-363. (C) 2009 wiley-Liss, Inc.