Results
Study population
From September 2018 to February 2021, 652 children were hospitalized
with a diagnosis of bronchiolitis. Of them, 174 were not eligible for
our study (Figure 1 ). A total of 268 children’s reports were
investigated for the predictive factors of the LOFR; and 478 were
investigated for the LOS.
The median age of our sample was 3.2 months (1.6 - 5.4), 263 children
were boys (55.0 %) and the median weight was 5.9 kg (4.5 - 7.2).
Briefly, 94 children had a familial history of atopy (19.7%) and 69
were born premature (14.4%). The median LOFR was 1.0 days (0.6 - 2.0)
and the median LOS was 2.9 days (2.0 - 4.8). Table 1 presents
the demographic and clinical characteristics of the patients, their
comorbidities, the parameters at ED arrival and course of the stay (when
available).
Factors associated with the LoFR and the
LOS
In the univariate logistic regression model for LOFR: time delay between
the first symptoms and the ED arrival (consultation time), RR ≥ 70/min
or < 30/min or apnea, moderate use of accessory muscles and
nutritional support requirement were significantly associated with the
LOFR (E-Table 2 ). In the multiple logistic regression
model, none of the investigated associations reached statistical
significance, but the estimate comes with uncertainty ranging from
virtually no association to a significant positive association (95% CI
for the OR: 1.0 to 2.6) for the moderate use of accessory muscles,
nutritional support and RR ≥ 70/min or < 30/min or apnea that
could be associated with the LOFR (Table 2 ).
In the univariate logistic regression model for LOS: age, weight,
consultation time, severe clinical condition, RR ≥ 70/min or <
30/min or apnea, SpO2% < 90 % or cyanosis, intense use of
accessory muscles, nutritional and oxygen support requirement were
significantly associated with the LOS (E-Table 2 ). In
the multiple logistic regression model, the intense use of accessory
muscles (OR=3.9, 95%CI 1.6 - 10.4, p=0.004), the severe clinical
condition (OR=2.8, 95%CI 1.7 - 4.8, p=0.001), and other known
variables, such as the O2 supplementation (OR=2.0, 95%CI 1.3 - 3.1,
p=0.003) remained significantly associated with the LOS and the effect
is large enough to be worthwhile (Table 2 ). For the
consultation time (OR=1.2, 95%CI 1.1 - 1.3, p=0.001) and the age
(OR=0.8, 95%CI 0.7 - 0.9, p<0.01), even if they remained
significantly associated with the LOS, the effect may or may not be
worthwhile.
In-hospital referral for
ACT
Of the 478 infants included in our study, 299 (63%) were referred for
ACT during their hospital stay (ACT+). Children in the ACT+ group were
significantly older (median age 2.6 (1.5-5.0) vs 3.5 (1.8-5.8) years;
p=0.011) and heavier (median weight 5.3 (4.1-6.8) vs. 6.20 (5.0-7.5) kg;
p<0.01) compared to those in the ACT- group. Similarly,
children in the ACT+ group were less severe at admission and were more
often prescribed bronchodilators but required less nutritional support.
The complete characteristics of both groups are presented in theTable 3 .