Department of Pediatric and Adolescent Medicine, Akershus University Hospital, Sykehusveien 25, 1478, Nordbyhagen, Norway.
Division of Paediatric and Adolescent Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Eur J Pediatr. 2021 Aug;180(8):2473-2483. doi: 10.1007/s00431-021-04057-4. Epub 2021 Apr 8.
Viral lower respiratory tract infection (VLRTI) is the most common cause of hospital admission among small children in high-income countries. Guidelines to identify children in need of admission are lacking in the literature. In December 2012, our hospital introduced strict guidelines for admission. This study aims to retrospectively evaluate the safety and efficacy of the guidelines. We performed a single-center retrospective administrative database search and medical record review. ICD-10 codes identified children < 24 months assessed at the emergency department for VLRTI for a 10-year period. To identify adverse events related to admission guidelines implementation, we reviewed patient records for all those discharged on primary contact followed by readmission within 14 days. During the study period, 3227 children younger than 24 months old were assessed in the ED for VLRTI. The proportion of severe adverse events among children who were discharged on their initial emergency department contact was low both before (0.3%) and after the intervention (0.5%) (p=1.0). Admission rates before vs. after the intervention were for previously healthy children > 90 days 65.3% vs. 53.3% (p<0.001); for healthy children ≤ 90 days 85% vs. 68% (p<0.001); and for high-risk comorbidities 74% vs. 71% (p=0.5).Conclusion: After implementation of admission guidelines for VLRTI, there were few adverse events and a significant reduction in admissions to the hospital from the emergency department. Our admission guidelines may be a safe and helpful tool in the assessment of children with VLRTI. What is Known: • Viral lower respiratory tract infection, including bronchiolitis, is the most common cause of hospitalization for young children in the developed world. Treatment is mainly supportive, and hospitalization should be limited to the cases in need of therapeutic intervention. • Many countries have guidelines for the management of the disease, but the decision on whom to admit for inpatient treatment is often subjective and may vary even between physicians in the same hospital. What is New: • Implementation of admission criteria for viral lower respiratory tract infection may reduce the rate of hospital admissions without increasing adverse events.
病毒性下呼吸道感染（VLRTI）是高收入国家小儿住院的最常见原因。文献中缺乏确定需要住院治疗的儿童的指南。2012 年 12 月，我们医院引入了严格的住院指南。本研究旨在回顾性评估该指南的安全性和有效性。我们进行了一项单中心回顾性行政数据库搜索和病历回顾。ICD-10 编码确定了在急诊科接受 VLRTI 评估的 24 个月以下儿童，为期 10 年。为了确定与入院指南实施相关的不良事件，我们对所有在急诊科初次就诊后出院且在 14 天内再次入院的患者进行了病历回顾。在研究期间，3227 名 24 个月以下的儿童在急诊科因 VLRTI 接受评估。在干预前后，在急诊科初次就诊时出院的儿童中严重不良事件的比例均较低（分别为 0.3%和 0.5%）（p=1.0）。干预前后的入院率分别为：既往健康儿童>90 天为 65.3%比 53.3%（p<0.001）；健康儿童≤90 天为 85%比 68%（p<0.001）；合并高危并发症的为 74%比 71%（p=0.5）。结论：在实施 VLRTI 住院指南后，不良事件很少，从急诊科到医院的住院人数显著减少。我们的入院指南可能是评估 VLRTI 患儿的一种安全且有用的工具。已知的：•病毒性下呼吸道感染，包括细支气管炎，是发达国家儿童住院的最常见原因。治疗主要是支持性的，住院治疗应仅限于需要治疗干预的病例。•许多国家都有该疾病的管理指南，但住院治疗的决策通常是主观的，即使在同一医院的医生之间也可能存在差异。新的：•实施病毒性下呼吸道感染的入院标准可能会降低住院率，而不会增加不良事件。
