+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Prospective multicenter study of bronchiolitis: predicting safe discharges from the emergency department



Prospective multicenter study of bronchiolitis: predicting safe discharges from the emergency department



Pediatrics 121(4): 680-688



Bronchiolitis is the leading cause of hospitalization for infants. Our objective was to identify factors associated with safe discharge to home from the emergency department. We conducted a prospective cohort study during 2 consecutive bronchiolitis seasons, from 2004 to 2006. Thirty US emergency departments contributed data. All patients were < 2 years of age and had a final emergency department attending physician diagnosis of bronchiolitis. Using multivariate logistic regression, a low-risk model was developed with a random half of the data and then validated with the other half. Of 1456 enrolled patients, 837 (57%) were discharged home from the emergency department. The following factors predicted safe discharge to home: age of > or = 2 months, no history of intubation, a history of eczema, age-specific respiratory rates (< 45 breaths per minute for 0-1.9 months, < 43 breaths per minute for 2-5.9 months, and < 40 breaths per minute for 6-23.9 months), no/mild retractions, initial oxygen saturation of > or = 94%, fewer albuterol or epinephrine treatments in the first hour, and adequate oral intake. The importance of each factor varied slightly according to age, but the comprehensive model (developed and validated for all children < 2 years of age) yielded an area under the receiver operating characteristic curve of 0.81, with a good fit of the data. This large multicenter study of children presenting to the emergency department with bronchiolitis identified several factors associated with safe discharge, including cut points for respiratory rate and oxygen saturation. Although the low-risk model requires further study, we believe that it will assist clinicians evaluating children with bronchiolitis and may help reduce some unnecessary hospitalizations.

Please choose payment method:






(PDF emailed within 0-6 h: $19.90)

Accession: 021613287

Download citation: RISBibTeXText

PMID: 18381531

DOI: 10.1542/peds.2007-1418


Related references

Prospective multicenter study of the viral etiology of bronchiolitis in the emergency department. Academic Emergency Medicine 15(2): 111-118, 2008

Prospective multicenter study of bronchiolitis: predictors of an unscheduled visit after discharge from the emergency department. Academic Emergency Medicine 17(4): 376-382, 2010

Factors associated with longer emergency department length of stay for children with bronchiolitis : a prospective multicenter study. Pediatric Emergency Care 25(10): 636-641, 2009

Nasopharyngeal lactate dehydrogenase concentrations predict bronchiolitis severity in a prospective multicenter emergency department study. Pediatric Infectious Disease Journal 31(7): 767-769, 2012

Prospective multicenter bronchiolitis study: predicting intensive care unit admissions. Academic Emergency Medicine 15(10): 887-894, 2008

Evaluation of compliance with palivizumab recommendations in a multicenter study of young children presenting to the emergency department with bronchiolitis. Pediatric Emergency Care 23(6): 362-367, 2007

Pediatricians' attitudes and costs of bronchiolitis in the emergency department: a prospective multicentre study. Pediatric Pulmonology 49(10): 1011-1019, 2014

Point-of-care lung ultrasound in infants with bronchiolitis in the pediatric emergency department: a prospective study. European Journal of Pediatrics 178(5): 623-632, 2019

Emergency Department-initiated Home Oxygen for Bronchiolitis: A Prospective Study of Community Follow-up, Caregiver Satisfaction, and Outcomes. Academic Emergency Medicine 24(8): 920-929, 2017

Criteria for the safe use of D-dimer testing in emergency department patients with suspected pulmonary embolism: a multicenter US study. Annals of Emergency Medicine 39(2): 144-152, 2002

Prospective multicenter study of relapse following emergency department treatment of COPD exacerbation. Chest 125(2): 473-481, 2004

Predicting Appropriate Admission of Bronchiolitis Patients in the Emergency Department: Rationale and Methods. Jmir Research Protocols 5(1): E41, 2016

Influence of sex on the use of cardiac procedures in patients presenting to the emergency department. A prospective multicenter study. Circulation 94(9 Suppl.): Ii93-Ii98, 1996

Reliability of electronic recording of waiting times in the emergency department: a prospective multicenter study. European Journal of Emergency Medicine 22(5): 366-369, 2015

Diagnostic and prognostic value of presepsin in the management of sepsis in the emergency department: a multicenter prospective study. Critical Care 17(4): R168, 2013