Corneli Howard M, Zorc Joseph J, Holubkov Richard, Bregstein Joan S, Brown Kathleen M, Mahajan Prashant, Kuppermann Nathan
University of Utah and Primary Children's Medical Center, Salt Lake City, UT, USA.
Pediatr Emerg Care. 2012 Feb;28(2):99-103. doi: 10.1097/PEC.0b013e3182440b9b.
Bronchiolitis is a leading cause of infant hospitalization in the United States; the mean length of stay (LOS) is 3.3 days. We sought to identify the initial clinical characteristics of bronchiolitis associated with admission and with longer LOS in a large multicenter clinical trial.
This study was a secondary analysis of a randomized trial conducted in 20 emergency departments in the Pediatric Emergency Care Applied Research Network. We examined age, sex, days of illness, Respiratory Distress Assessment Instrument score, vital signs, and oxygen saturation by pulse oximetry (SpO(2)) at presentation in 598 infants aged 2 to 12 months with moderate to severe bronchiolitis. We used classification and regression tree and logistic regression analyses to identify associations with admission and longer LOS (defined as LOS > 1 night).
Of the 598 infants, 240 (40%) were hospitalized; two thirds underwent longer LOS. The best predictor of hospitalization was initial SpO(2) value of less than 94%, followed by Respiratory Distress Assessment Instrument score of greater than 11 and respiratory rate of greater than 60. For this model, the sensitivity was 56% (95% confidence interval, 50%-62%) and the specificity was 74% (95% confidence interval, 70%-79%). Among admitted patients, the only decision point for prediction of longer LOS was initial SpO(2) value of 97% or less.
A model using objective findings had limited accuracy for predicting hospitalization after emergency department evaluation for bronchiolitis. In these infants with moderate to severe bronchiolitis, however, initial SpO(2) was the best predictor of hospital admission and of longer LOS. Efforts to better define and manage hypoxemia in bronchiolitis may be helpful.
在美国，细支气管炎是婴儿住院的主要原因；平均住院时间（LOS）为3.3天。我们试图在一项大型多中心临床试验中确定与入院及较长住院时间相关的细支气管炎的初始临床特征。
本研究是对在儿科急诊应用研究网络的20个急诊科进行的一项随机试验的二次分析。我们检查了598名2至12个月患有中度至重度细支气管炎的婴儿就诊时的年龄、性别、患病天数、呼吸窘迫评估仪器评分、生命体征以及经脉搏血氧饱和度测定法（SpO₂）测得的血氧饱和度。我们使用分类回归树和逻辑回归分析来确定与入院及较长住院时间（定义为住院时间>1晚）的关联。
在598名婴儿中，240名（40%）住院；其中三分之二住院时间较长。住院的最佳预测指标是初始SpO₂值低于94%，其次是呼吸窘迫评估仪器评分大于11以及呼吸频率大于60。对于该模型，敏感性为56%（95%置信区间，50%-62%），特异性为74%（95%置信区间，70%-79%）。在入院患者中，预测较长住院时间的唯一决策点是初始SpO₂值为97%或更低。
在急诊科对细支气管炎进行评估后，使用客观检查结果的模型预测住院的准确性有限。然而，在这些患有中度至重度细支气管炎的婴儿中，初始SpO₂是入院及较长住院时间的最佳预测指标。更好地定义和管理细支气管炎中的低氧血症的努力可能会有所帮助。
