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The modified respiratory index score (RIS) guides resource allocation in acute bronchiolitis
Author(s) -
Chong ShuLing,
Teoh Oon Hoe,
Nadkarni Nivedita,
Yeo Joo Guan,
Lwin Zaw,
Ong YongKwang Gene,
Lee Jan Hau
Publication year - 2017
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/ppul.23663
Subject(s) - medicine , bronchiolitis , wheeze , odds ratio , confidence interval , pediatrics , asthma , emergency department , respiratory sounds , prospective cohort study , respiratory disease , severity of illness , respiratory system , lung , psychiatry
Summary Background and Objective Bronchiolitis is a common disease in early childhood with increasing healthcare utilization. We aim to study how well a simple and improved respiratory score (the modified Respiratory Index Score [RIS]) would perform when predicting for a warranted admission. Methods This is an observational prospective study, from June 2015 to December 2015 in a paediatric emergency department (ED) of a large tertiary hospital in Singapore. We included children aged less than 2 years old, presenting with typical symptoms and signs of bronchiolitis but excluded children with four or more previous wheezes, a gestation of <35 weeks, and known cardiopulmonary disease. We also performed a sensitivity analysis for children presenting with their first wheeze. We defined a warranted admission as a composite of: The need for airway intervention, intravenous hydration, and a hospital stay of 2 days or more. Results Among 1,818 patients, the median age was 10.8 months (IQR 7.2–15.9). The median modified RIS score was 4.0 (IQR 3.0–5.0). A total of 19 (1.0%) children required respiratory support, 101 (5.6%) received intravenous hydration, and 571 (31.4%) required a hospital stay of 2 days or more. After adjusting for age and duration of illness, a modified RIS score of >4 predicted significantly for a warranted admission (adjusted Odds Ratio: 3.28, 95% confidence interval: 2.62–4.12). The association remained significant among children presenting with their first wheeze. Conclusions This simple respiratory tool predicts for the need for respiratory support, intravenous hydration, and a significant hospital stay of 2 days or more. Pediatr Pulmonol. 2017; 52:954–961. © 2017 Wiley Periodicals, Inc.