Factors predicting prolonged hospital stay for infants with bronchiolitis. J Hosp Med 2011 May;6(5):264-70
Date
06/11/2011Pubmed ID
21661099DOI
10.1002/jhm.903Scopus ID
2-s2.0-79958719368 (requires institutional sign-in at Scopus site) 27 CitationsAbstract
BACKGROUND: Prior prediction models for length of stay (LOS) in bronchiolitis have focused more on birth- and disease-related risk factors than on early hospital course factors, particularly common clinical markers including respiratory status and caloric intake.
OBJECTIVES: 1) Study the associations of various clinical markers and LOS; and 2) develop a LOS prediction model.
DESIGN: Retrospective cohort study.
SETTING: Children's Hospital of Wisconsin.
PATIENTS: Inclusion criteria were: age < 365 days old; admission between November 1, 2004 and April 15, 2005; final diagnosis of bronchiolitis; placement on the bronchiolitis treatment protocol; and lack of concurrent condition impacting LOS.
RESULTS: During the study period, 272/347 infants admitted with bronchiolitis met inclusion criteria. On hospital day 2, infants in the prolonged LOS group (≥ 108 hours) had a significantly greater number of hours on supplemental oxygen, maximum supplemental oxygen use, minimum supplemental oxygen use, maximum respiratory rate, mean respiratory score, and number of times suctioned. They had significantly lower minimum oxygen saturation and caloric intake. Recursive partitioning demonstrated five variables (hours of supplemental oxygen, maximum respiratory rate, minimum supplemental oxygen use, gestation, and caloric intake) to predict short or prolonged LOS with an area under the receiver-operator characteristic curve of 0.89/0.72 in the learning/test trees; sensitivity, 0.85; and specificity, 0.82.
CONCLUSIONS: There are important differences between infants with bronchiolitis having short and prolonged hospital stays, including several clinical markers identifiable on hospital day 2. This model may be a useful prediction tool for targeting early interventions for high-risk infants.
Author List
Weisgerber MC, Lye PS, Li SH, Bakalarski D, Gedeit R, Simpson P, Gorelick MHAuthors
Rainer G. Gedeit MD Associate Chief Medical Officer in the Children's Administration department at Children's WisconsinPippa M. Simpson PhD Adjunct Professor in the Pediatrics department at Medical College of Wisconsin
Michael C. Weisgerber MD Professor in the Pediatrics department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
BronchiolitisCohort Studies
Female
Forecasting
Hospitalization
Humans
Infant
Length of Stay
Male
Oxygen Inhalation Therapy
Retrospective Studies
