Clinical markers identified for length of infant bronchiolitis hospital stay
MedWire News: Clinical markers available on day 2 of hospitalization for infant bronchiolitis can predict whether the patient is likely to have a prolonged overall stay or not, report US researchers.
"The early risk assessment could allow more effective targeting of interventions to help high-risk infants," say Michael Weisgerber (Medical College of Wisconsin, Milwaukee) and colleagues.
The team assessed the associations between various clinical markers identifiable during the first 2 days of hospital admission for bronchiolitis, and length of stay (LOS), in a retrospective study of 272 infants below 1 year of age treated at their institution.
LOS was defined as longer than 108 hours, which represents the 80th percentile LOS at the Milwaukee hospital, explain the researchers. A total of 47 infants had a prolonged LOS, which was a median 59 hours overall.
Baseline characteristics did not differ significantly between infants with prolonged and short LOS, however, significantly more of those in the long-stay group required respiratory support at birth.
With reference to day 1 of their hospital stay, infants in the prolonged LOS group had a significantly greater need for supplemental oxygen, and a significantly higher mean respiratory score compared with infants with a short LOS.
On day 2, prolonged LOS patients had significantly greater need for supplemental oxygen, maximum respiratory rate, mean respiratory score, and number of times they were suctioned. They also had significantly lower minimum oxygen saturation and caloric intake compared with their short-stay counterparts.
Hospital day 2 saw more prolonged LOS patients in the intensive care unit, on continuous positive airway pressure, and on ventilators.
Weisgerber and team created a recursive partitioning model, to be used for LOS prediction, that included hours of supplemental oxygen, maximum respiratory rate, minimum supplemental oxygen use, gestation, and kilocalories per kilogram per day consumed.
The sensitivity and specificity of this model using receiver operating characteristic analysis was 0.85 and 0.82, which, for sensitivity, was comparable with the Michigan and Rotterdam models for LOS prediction, but was higher in specificity than these other two models.
A good specificity means the model will limit the number of false positives, remark the researchers, whereby infants who appear destined for a prolonged LOS after screening, actually end up having a short LOS.
"For clinicians or researchers planning interventions for high-risk infants, this greater specificity would reduce the number of infants who might unnecessarily receive those interventions," they conclude in the Journal of Hospital Medicine.
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By Sarah Guy