Predictors of admission in patients with acute Bronchiolitis

Abstract

Background: Acute viral bronchiolitis represents the most common lower respiratory tract infection in infants and young children less than 24 months and is associated with substantial morbidity and mortality. Respiratory syncytial virus is the most frequently identified virus, but many other viruses may also cause acute bronchiolitis. Most children with bronchiolitis have a self-limiting mild disease and can be safely managed at home with careful attention to feeding and respiratory status. Criteria for referral and admission vary between hospitals as do clinical practice in the management of acute viral bronchiolitis, Supportive care, including administration of oxygen and fluids, is the cornerstone of current treatment. Aim: To identify the epidemiological profile of babies less than 2 years with bronchiolitis, clinical characteristics of babies with bronchiolitis in respect to the main symptoms, signs and clinical presentations and the factors that affect disposition of the patient with acute bronchiolitis. Patient and Method: Design: A prospective observational case series study. Setting: Emergency unit in Al-Khansaa Teaching Hospital. Study period: one-year (1/October/ 2012 – 30/September/ 2013) Sample size: 84 patients were enrolled in this study. Inclusion criteria: 1-first attack of acute wheeze due to bronchiolitis.2-age 2years or younger. Exclusion criteria: 1. patients with more than one attack wheezes.2. wheezes due to other cause (pneumonia).3.age more than 2 years. Result: A Total of 84 patients with 1st attack wheeze in less than 2 years identified. The main age was 8.2±5.77months, and the peak age was 6 months.53 (63.1%) male, and 31(36.9%) female and ratio of 1.7:1.and the majority were mature babies, came from urban area more than rural area. The comparison done concentrated on symptoms, signs, and radiological findings between babies younger and older than 6months age and studied either to hospital or not and concentrated these findings had role as an indicator for admission on heart rate, respiratory rate and SPO2, The results indicated that poor feeding, irritability, runny nose, cough and shortness of breath all of these symptoms consider a good indicators for admission in both age groups. Severe retraction, rhonchi, and temperature more than 38.1 C, all of these physical findings consider good indicators of admission in both age groups. While fine rales and cyanosis are good indicators in babies younger than 6 months only. Radiological findings had no role in assessing admission of the patients to hospital. Respiratory rate (tachypnea)>60 bpm, and SPO2 160 BPM consider significant indicator only in babies older than 6 months of age. Of all 84 patients admitted to emergency unit, only 63(75%) of them were admitted to hospital and the remaining were discharged. Conclusion: Indications of admission can be assessed by many symptoms (poor feeding, irritability, runny nose, cough, and SOB) and physical signs (Rhonchi, severe retraction, temperature >38.1 c, RR>60bpm, and SPO2<94), so We recommended carrying out serial checking SPO2 by pulse oximetry, and to conduct arterial or capillary blood gas analysis for the severely ill patients to assess the severity of the disease and its complications and treatment procedures.