Discharge Criteria for Bronchiolitis

Garcia-Maurino, Cristina; Moore‐Clingenpeel, Melissa; Wallihan, Rebecca; Korányi, Katalin; Rajah, Bavani; Shirk, Tiffany; Vegh, Maria; Ramilo, Octavio; Mejías, Asunción

doi:10.1097/inf.0000000000001836

Cited by 13 publications

(20 citation statements)

References 45 publications

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“…One study found differences in LOS and hospital costs correlated to differences in care practices between hospitals [ 35 ]. Another study found reduction in LOS after introduction of discharge criteria [ 36 ].…”

Section: Discussionmentioning

confidence: 99%

Viral lower respiratory tract infections—strict admission guidelines for young children can safely reduce admissions

et al. 2021

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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.

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Section: Discussionmentioning

confidence: 99%

Viral lower respiratory tract infections—strict admission guidelines for young children can safely reduce admissions

et al. 2021

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“…Most parents of hospitalised children reported that they would have preferred to have been given clear discharge criteria by their physicians. This could be challenging to implement, as there are no universal discharge criteria for bronchiolitis and subsequent practice variations 31 . Paediatricians should try to identify potential discharge criteria with the parents, at the time of admission, and adapt them to each patient and family.…”

Section: Discussionmentioning

confidence: 99%

“…This could be challenging to implement, as there are no universal discharge criteria for bronchiolitis and subsequent practice variations. 31 Paediatricians should try to identify potential discharge criteria with the parents, at the time of admission, and adapt them to each patient and family.…”

Section: Discussionmentioning

confidence: 99%

Parents' perspectives, information needs and healthcare preferences when consulting for their children with bronchiolitis: A qualitative study

et al. 2020

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Aim Bronchiolitis is the leading cause of hospitalisation in infants, but parental experiences have not been well described. This study explored parents’ experiences and asked them how they wanted to receive information. Methods A qualitative study was conducted in a tertiary paediatric hospital in Québec, Canada. It consisted of semi‐structured interviews with 15 parents of 13 children with bronchiolitis. The interview guide was constructed by a multidisciplinary team that included a parent. The interviews, which were transcribed verbatim, were conducted until no new themes emerged. Results We interviewed eight mothers, three fathers and two couples for 22‐70 minutes: six were carried out in person during the bronchiolitis episode, and seven were phone interviews after a median interval time of 107 days. Parents were very worried about their child’s health and their lack of knowledge about bronchiolitis contributed to their anxiety. They found education resources informative, but expressed a strong need for support and reassurance from healthcare teams. The two groups provided similar feedback, regardless of when they were interviewed or whether their child was admitted. Conclusion Although bronchiolitis is common in infancy, parental knowledge was low. Standardised educational tools were useful, but insufficient to meet all their needs.

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“…We read with interest the comments from Korppi in relation to our recently published study describing the utility of established discharge criteria for infants and young children with bronchiolitis. 1 Bronchiolitis remains the number one cause of hospitalization in infants and is associated with significant morbidity, 2 yet, despite being one of the most common diseases of childhood, we lack a standard definition, with some countries including in their guidelines infants only and others children up to 2 years of age. 3–5 Nonetheless, as mentioned by Korppi, the major impact of respiratory syncytial virus bronchiolitis occurs during the first year of life, and the peak of severe respiratory syncytial virus (RSV) disease in the first 6 months of life.…”

Section: To the Editorsmentioning

confidence: 99%

“…In our study, the majority of children [85% (946/1118) in Infectious Diseases (ID), where the discharge protocol was used, and 73% (509/695) in non-ID units] were younger than 12 months of age, while the cohort of infants younger than 6 months of age represented 61% (687/1118) of ID patients and 47% (330/695) of children with bronchiolitis discharged from non-ID units. 1 If we were to limit the analyses to this very young population, we would have left out of the study half of the children hospitalized with this disease. The discharge protocol that we used included different parameters that were age-specific.…”

Section: To the Editorsmentioning

confidence: 99%