SAN DIEGO – Children with a high bronchiolitis risk of admission score are more likely to require longer hospital stays, results from a single-center study showed.
“There’s no tool in the published literature we’re aware of that helps you predict how long a child with bronchiolitis will need to be in the hospital for,” Dr. Matko Marlais said in an interview at the annual meeting of the American Academy of Pediatrics. Such information would be helpful, he continued, because “if the child is quite well, but they still need admission we might decide to put them on the observation ward for 24 hours. But if they’re really unwell, we might decide to put them in the hospital ward as an inpatient. It’s helpful to make that decision at the point of the emergency room triage.”
Dr. Matko Marlais
The 5-point bronchiolitis risk of admission score (BRAS) was developed as a way to help predict the requirement for admission in infants with acute bronchiolitis, and it was validated with this outcome in mind. Points are assigned on the association between the infant and certain factors including duration of symptoms, respiratory rate, heart rate, oxygen saturation, and age at presentation (Arch. Dis. Child. 2011;96:648-52). In an effort to determine whether use of BRAS in the emergency room is able to predict the level of care and length of hospital stay in infants with acute bronchiolitis, Dr. Marlais and his associates evaluated the medical records of all infants who presented to the department of pediatric emergency medicine at Chelsea and Westminster Hospital, London, with the condition during a 12-month period. The analysis was limited to infants up to 1 year of age who required hospitalization.
Clinicians applied the BRAS at the point of emergency room triage and extracted data for each patient from a review of clinical notes, including clinical features at presentation, length of resultant hospital stay, and level of care required (supportive care or noninvasive ventilation via nasal continuous positive airway pressure [CPAP]). The researchers used Spearman Rank correlation coefficient to determine if the BRAS was correlated with the length of hospital stay.
Dr. Marlais reported findings from 163 infants included in the analysis. Of these, 54% were male and their mean age at presentation was 18 weeks. The majority of infants (83%) only required supportive care during their admission, while 17% required noninvasive ventilation via nasal CPAP.
The mean hospital length of stay was 3 days, with a range of 1-30 days. The researchers found that the bronchiolitis risk of admission score was correlated with length of hospital stay (correlation coefficient of 0.47; P< .0001). They also observed that infants who required noninvasive ventilation via CPAP had a significantly higher BRAS, compared with those who required only supportive care (a mean score of 4.14 vs. 3.01, respectively; P< .0001).
“The child with the highest score in this cohort is much more likely to need a hospital stay for 3, 4 or 5 days rather than a child with a lower score,” said Dr. Marlais of the hospital. The association “helps us in managing their flow through the hospital and in giving the parents a bit of an indication as to how long they’ll need to be in the hospital.”
While he characterized the findings as “fairly expected,” he acknowledged certain limitations of the study, including the fact that BRAS “wasn’t developed with [hospital] length of stay as the outcome in mind. It was developed to predict the need for hospital admission. Technically, we would need to develop a new score looking at the predictive factors specifically for length of stay. We haven’t done that.”
Dr. Marlais reported having no relevant financial disclosures.
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