Feasibility study to derive a clinical decision rule for predicting severe bronchiolitis

Abstract

Statement of problem. Bronchiolitis is a common childhood lower respiratory tract infection. Determining risk of developing severe disease is important. Methods. 312 children, aged ≤ 12 months, with bronchiolitis were prospectively enrolled over 5 months at 2 emergency departments. We assessed 22 standardized variables and clinical outcome. A decision rule predicting severe bronchiolitis (apnea, intubation, pediatric ICU admission, death) was derived using chi2 recursive partitioning techniques. Results. 8 children (2.6 %) developed severe bronchiolitis. Age, length of breastfeeding, heart rate (HR) and systolic blood pressure outside normal, respiratory exam score, oxygen saturation, and lung atelectasis were associated (p < 0.05) with severe bronchiolitis. Preliminary decision rule included (1) heart rate outside normal range and (2) oxygen saturation < 88%. Rule sensitivity was 100% (95% CI 68,100) and specificity was 93% (95% CI 90,96). Conclusion. Small sample size resulted in the rule's large CIs. Successful model development suggests a decision rule is feasible.