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Predicting Escalated Care in Recurrent Wheezing Infants
  • Jefferson Buendia,
  • Carlos Rodriguez-Martinez,
  • Ranniery Acuña-Cordero
Jefferson Buendia
University of Antioquia
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Carlos Rodriguez-Martinez
Universidad Nacional de Colombia
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Ranniery Acuña-Cordero
Hospital Militar Central
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Abstract

Introduction The risk stratification of infants presenting to the emergency department with bronchiolitis who are at risk for receiving airway support during their hospital stay has been insufficiently studied. The aim of this study was to determine the clinical predictors of hospitalization with airway support (“escalated care”) among infants with recurrent wheezing evaluated in the emergency department Methods: We conducted a retrospective cohort study in infants with one or more wheezing episode, younger than two years of age in tertiary centers in Rionegro, Colombia. The primary outcome measure was escalated care defined as hospitalization plus any airway support. A multivariate logistic regression model was performed to estimate predictors of escalated care. To assess discrimination and calibration, area-under-the-curve (AUC) and calibration plots were calculated. Results A total of 665 cases were included and 85 infants received escalated care. The variables included risk score for escalated care within 5 days of admission to the emergency room including prematurity, poor feeding, nasal flaring and/or grunting, and previous wheezing episodes requiring hospitalization, The model has a high specificity (99.6%) with acceptable AUC of 0.70 (CI 95% 0.60- 0.74). Conclusion: A clinical risk score was created based on the odds ratio of each of the identified variables, which appears to be useful for estimating the absolute risk of escalated care within 5 days of admission to the ED. However, external validation is required before this clinical score is applied in general practice in any ED setting

Peer review status:UNDER REVIEW

30 Aug 2020Submitted to Pediatric Pulmonology
31 Aug 2020Assigned to Editor
31 Aug 2020Submission Checks Completed
05 Sep 2020Reviewer(s) Assigned
16 Sep 2020Review(s) Completed, Editorial Evaluation Pending