TY - JOUR
T1 - Hospital course and discharge criteria for children hospitalized with bronchiolitis
AU - for the MARC-30 Investigators
AU - Mansbach, Jonathan M.
AU - Clark, Sunday
AU - Piedra, Pedro A.
AU - Macias, Charles G.
AU - Schroeder, Alan R.
AU - Pate, Brian M.
AU - Sullivan, Ashley F.
AU - Espinola, Janice A.
AU - Camargo, Carlos A.
AU - Barcega, Besh
AU - Cheng, John
AU - Damore, Dorothy
AU - Delgado, Carlos
AU - Haddad, Haitham
AU - Hain, Paul
AU - Carell, Monroe
AU - LoVecchio, Frank
AU - Macias, Charles
AU - Mansbach, Jonathan
AU - Mowad, Eugene
AU - Pate, Brian
AU - Riederer, Mark
AU - Jason Sanders, M.
AU - Shah, Nikhil
AU - Stevenson, Michelle
AU - Fisher, Erin Stucky
AU - Teach, Stephen
AU - Zaoutis, Lisa
N1 - Publisher Copyright:
© 2015 Society of Hospital Medicine.
PY - 2015/4/1
Y1 - 2015/4/1
N2 - BACKGROUND: For children hospitalized with bronchiolitis, there is uncertainty about the expected inpatient clinical course and when children are safe for discharge. OBJECTIVES: Examine the time to clinical improvement, risk of clinical worsening after improvement, and develop discharge criteria. DESIGN: Prospective multiyear cohort study. SETTING: Sixteen US hospitals. PARTICIPANTS: Consecutive hospitalized children age <2 years with bronchiolitis. MEASUREMENT: We defined clinical improvement using: (1) retraction severity, (2) respiratory rate, (3) room air oxygen saturation, and (4) hydration status. After meeting improvement criteria, children were considered clinically worse based on the inverse of ≥1 of these criteria or need for intensive care. RESULTS: Among 1916 children, the median number of days from onset of difficulty breathing until clinical improvement was 4 (interquartile range, 3-7.5 days). Of the total, 1702 (88%) met clinical improvement criteria, with 4% worsening (3% required intensive care). Children who worsened were age <2 months (adjusted odds ratio [AOR]: 3.51; 95% confidence interval [CI]: 2.07-5.94), gestational age <37 weeks (AOR: 1.94; 95% CI: 1.13-3.32), and presented with severe retractions (AOR: 5.55; 95% CI: 2.12-14.50), inadequate oral intake (AOR: 2.54; 95% CI: 1.39-4.62), or apnea (AOR: 2.87; 95% CI: 1.45-5.68). Readmissions were similar for children who did and did not worsen. CONCLUSIONS: Although children hospitalized with bronchiolitis had wide-ranging recovery times, only 4% worsened after initial improvement. Children who worsened were more likely to be younger, premature infants presenting in more severe distress. For children hospitalized with bronchiolitis, these data may help establish more evidence-based discharge criteria, reduce practice variability, and safely shorten hospital length-of-stay.
AB - BACKGROUND: For children hospitalized with bronchiolitis, there is uncertainty about the expected inpatient clinical course and when children are safe for discharge. OBJECTIVES: Examine the time to clinical improvement, risk of clinical worsening after improvement, and develop discharge criteria. DESIGN: Prospective multiyear cohort study. SETTING: Sixteen US hospitals. PARTICIPANTS: Consecutive hospitalized children age <2 years with bronchiolitis. MEASUREMENT: We defined clinical improvement using: (1) retraction severity, (2) respiratory rate, (3) room air oxygen saturation, and (4) hydration status. After meeting improvement criteria, children were considered clinically worse based on the inverse of ≥1 of these criteria or need for intensive care. RESULTS: Among 1916 children, the median number of days from onset of difficulty breathing until clinical improvement was 4 (interquartile range, 3-7.5 days). Of the total, 1702 (88%) met clinical improvement criteria, with 4% worsening (3% required intensive care). Children who worsened were age <2 months (adjusted odds ratio [AOR]: 3.51; 95% confidence interval [CI]: 2.07-5.94), gestational age <37 weeks (AOR: 1.94; 95% CI: 1.13-3.32), and presented with severe retractions (AOR: 5.55; 95% CI: 2.12-14.50), inadequate oral intake (AOR: 2.54; 95% CI: 1.39-4.62), or apnea (AOR: 2.87; 95% CI: 1.45-5.68). Readmissions were similar for children who did and did not worsen. CONCLUSIONS: Although children hospitalized with bronchiolitis had wide-ranging recovery times, only 4% worsened after initial improvement. Children who worsened were more likely to be younger, premature infants presenting in more severe distress. For children hospitalized with bronchiolitis, these data may help establish more evidence-based discharge criteria, reduce practice variability, and safely shorten hospital length-of-stay.
UR - http://www.scopus.com/inward/record.url?scp=84926422167&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84926422167&partnerID=8YFLogxK
U2 - 10.1002/jhm.2318
DO - 10.1002/jhm.2318
M3 - Article
C2 - 25627657
AN - SCOPUS:84926422167
SN - 1553-5592
VL - 10
SP - 205
EP - 211
JO - Journal of hospital medicine
JF - Journal of hospital medicine
IS - 4
ER -