A validated clinical model to predict the need for admission and length of stay in children with acute bronchiolitis

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Abstract
To develop and validate a logistic regression model to predict need for admission and length of hospital stay in children presenting to the Emergency Department with bronchiolitis. Two children's hospitals in Dublin, Ireland. We reviewed 118 episodes of bronchiolitis in 99 children admitted from the Emergency Department. Those discharged within 24 h by a consultant/attending paediatrician were retrospectively categorized as suitable for discharge. We then validated the model using a cohort of 182 affected infants from another paediatric Emergency Department in a bronchiolitis season 2 years later. In the validation phase actual admission, failed discharge, and age less than 2 months defined the need for admission. The model predicted admission with 91% sensitivity and 83% specificity in the validation cohort. Age [odds ratio (OR) 0.86, 95% confidence interval (CI) 0.76–0.97], dehydration (OR 2.54, 95% CI 1.34–4.82), increased work of breathing (OR 3.39, 95% CI 1.29–8.92) and initial heart rate above the 97th centile (OR 3.78, 95% CI 1.05–13.57) predicted the need for admission and a longer hospital stay. We derived and validated a severity of illness model for bronchiolitis. This can be used for outcome prediction in decision support tools or severity of illness stratification in research/audit.