Hospital course and discharge criteria for children hospitalized with bronchiolitis

for the MARC-30 Investigators

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)205-211
Number of pages7
JournalJournal of Hospital Medicine
Volume10
Issue number4
DOIs
StatePublished - Apr 1 2015

Fingerprint

Bronchiolitis
Hospitalized Child
Odds Ratio
Confidence Intervals
Critical Care
Length of Stay
Apnea
Respiratory Rate
Premature Infants
Gestational Age
Uncertainty
Inpatients
Respiration
Cohort Studies
Air
Oxygen

ASJC Scopus subject areas

  • Health Policy
  • Assessment and Diagnosis
  • Care Planning
  • Fundamentals and skills
  • Leadership and Management

Cite this

Hospital course and discharge criteria for children hospitalized with bronchiolitis. / for the MARC-30 Investigators.

In: Journal of Hospital Medicine, Vol. 10, No. 4, 01.04.2015, p. 205-211.

Research output: Contribution to journalArticle

for the MARC-30 Investigators. / Hospital course and discharge criteria for children hospitalized with bronchiolitis. In: Journal of Hospital Medicine. 2015 ; Vol. 10, No. 4. pp. 205-211.
@article{d26c5c75b0a043b28b18e0282224e762,
title = "Hospital course and discharge criteria for children hospitalized with bronchiolitis",
abstract = "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.",
author = "{for the MARC-30 Investigators} and Mansbach, {Jonathan M.} and Sunday Clark and Piedra, {Pedro A.} and Macias, {Charles G.} and Schroeder, {Alan R.} and Pate, {Brian M.} and Sullivan, {Ashley F.} and Espinola, {Janice A.} and Camargo, {Carlos A.} and Besh Barcega and John Cheng and Dorothy Damore and Carlos Delgado and Haitham Haddad and Paul Hain and Monroe Carell and Frank LoVecchio and Charles Macias and Jonathan Mansbach and Eugene Mowad and Brian Pate and Mark Riederer and {Jason Sanders}, M. and Nikhil Shah and Michelle Stevenson and Fisher, {Erin Stucky} and Stephen Teach and Lisa Zaoutis",
year = "2015",
month = "4",
day = "1",
doi = "10.1002/jhm.2318",
language = "English (US)",
volume = "10",
pages = "205--211",
journal = "Journal of hospital medicine (Online)",
issn = "1553-5606",
publisher = "John Wiley and Sons Inc.",
number = "4",

}

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

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

VL - 10

SP - 205

EP - 211

JO - Journal of hospital medicine (Online)

JF - Journal of hospital medicine (Online)

SN - 1553-5606

IS - 4

ER -