Independent Predictors of Bronchiolitis Mortality After ED Discharge

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The odds of CCU admission or death were 25 times higher in infants with comorbidities and at least 2 other predictors vs infants without predictors.
The odds of CCU admission or death were 25 times higher in infants with comorbidities and at least 2 other predictors vs infants without predictors.

Infants with bronchiolitis and comorbidities plus other predictive factors are at higher risk for subsequent critical care unit (CCU) admission and death following discharge from the emergency department, according to data published in The Journal of Pediatrics.

A population-based cohort study using province-wide demographic and healthcare databases in Ontario, Canada, linked at the individual level assessed 34,270 infants with bronchiolitis discharged from emergency departments between 2003 and 2014.  Of these, 102 (0.3%) were admitted to the CCU or died after discharge.

Comorbidities (OR, 5.33; 95% CI, 2.82-10.10), younger age [months] (OR, 1.47; 95% CI, 1.33-1.61), low income (OR, 1.53; 95% CI, 1.01-2.34), younger gestational age [weeks] (OR, 1.14; 95% CI, 1.06-1.22), and emergent presentation (Canadian Triage and Acuity Scale 2) at the index visit (OR, 1.55; 95% CI, 1.03-2.33) were all identified as predictors of CCU admission or death.

The absolute event risk in infants with comorbidities compared with infants without was 1.5% vs 0.26%, respectively (P <.001). The odds of CCU admission or death were 25 times higher in infants with comorbidities and at least 2 other predictors than for infants without predictors.

The study was limited in its ability to detect statistical significance for several important variables, such as small-for-gestational-age status, parity, smoking, and lack of initiation of breastfeeding due to relatively small numbers of infants who died or were admitted to the CCU. 

Data on the duration of breastfeeding were also not available. In addition, the study was limited to infants aged 12 months, which limits the generalizability of the results to the 12-to-24 months age group.

The investigators identified several independent predictors of CCU admission or death associated with bronchiolitis shortly after emergency department discharge; namely, presence of comorbidities, emergent clinical presentation at the index visit, younger infant age, prematurity, and low household income. They recommend that these risk factors “should augment current clinical and social considerations regarding disposition of infants with bronchiolitis, particularly those with comorbidities.”

Reference

Schuh S, Kwong JC, Holder L, Graves E, Macdonald EM, Finkelstein Y. Predictors of critical care and mortality in bronchiolitis after emergency department discharges [published online April 24, 2018]. J Pediatr. doi:10.1016/j.jpeds.2018.04.010

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