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

Abstract

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.

Interventions to reduce acute paediatric hospital admissions: a systematic review

“…Of the seven papers included in the previous review, two were included in the present review 15,30 , three were published prior to 2000, one was published French and one did not meet inclusion criteria. Nineteen studies 9,10, 16,17,21,23,24,26,27,[31][32][33][34][35][36][37][38][39][40] were published after the search in the previous review. 11…”

“…Thirteen studies were from North America, 16,17,23,24,26,[28][29][30][34][35][36][37]39 eight from Europe, 9,10,15,21,22,31,32,38 six from Australia, 18,20,25,27,40,41 and one from Asia. 33 Nineteen studies had a before-and-after design and four 22,32,33,35 compared non-randomised assessment options within the same period.…”

“…25 Only one study 16 included any participants ≥18 years, and here 87% of participants were aged <13 years. The earliest studies began in 18,29 and the latest in 2017; 36 seven studies began between 1990-1999, 15,18,25,29,30 ten between 2000-2009 10,16,17,[22][23][24]28,31,35,38 and eleven after 2009. 9, 21,26,27,[32][33][34]36,37,39,40…”

“…Hospital admission was reported in studies, 9,10,15,16,[18][19][20]22,23,[25][26][27][28][29][30][31][32][34][35][36][38][39][40] readmission in nine, 17,[19][20][21]24,26,39 and length of stay in 15 studies. 10,16,[18][19][20][21]23,24,[26][27][28][29][30]36,37 The primary outcome was presented as odds ratio (OR) or relative risk (RR) of hospital admission [15][16][17]22,32,34,35...…”

“…10,16,[18][19][20][21]23,24,[26][27][28][29][30]36,37 The primary outcome was presented as odds ratio (OR) or relative risk (RR) of hospital admission [15][16][17]22,32,34,35,37,39,40 or as a percentage change. 10,[18][19][20][21][23][24][25][26][27][28][29][30][31]33,36,38…”