Use of simple clinical parameters to assess severity of bronchiolitis

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Abstract
To determine whether simple clinical parameters could be used to predict the severity of acute bronchiolitis and the need for supplemental oxygen therapy. A prospective study, performed in a tertiary care paediatric hospital. Seventy-one infants under 15 months of age with a clinical diagnosis of acute bronchiolitis were examined on admission. Clinical parameters were recorded, and each infant was re-examined after approximately 12 and 24 h. All infants were examined by one medical student and, when possible, by a doctor, the two being unaware of each other's findings. Parameters recorded included respiratory and heart rates and presence of wheeze, crackles, intercostal recession, sternal retraction and/or cyanosis. The outcome measure was the need for supplemental oxygen, as determined by the independent caring medical team, on the basis of pulse oximetry and clinical judgement. Forty (56%) of the 71 babies required supplemental oxygen. All cyanosed babies required supplemental oxygen, but only 9 (21%) were cyanosed on admission. Intercostal recession (relative risk RR 2.55; 95% CI 1.28, 5.08) and sternal retraction (RR 1.60; 95% CI 1.06, 2.42) predicted the need for supplemental oxygen with moderate accuracy. Interobserver agreement was only fair for most parameters, but was poor for intercostal recession and good for cyanosis. Simple clinical parameters may help predict the need for oxygen therapy in acute bronchiolitis, although further studies are required to define suitable clinical criteria. Such criteria are extremely important in developing countries where oxygen is a scarce resource.