The modified respiratory index score (RIS) guides resource allocation in acute bronchiolitis. Issue 7 (23rd January 2017)

• Record Type: Journal Article
• Authors: Chong, Shu‐Ling; Teoh, Oon Hoe; Nadkarni, Nivedita; Yeo, Joo Guan; Lwin, Zaw; Ong, Yong‐Kwang Gene; Lee, Jan Hau
• Is Part Of: Pediatric pulmonology. Volume 52:Issue 7(2017)
• Page Start: 954
• Page End: 961
• Publication Date: 2017-01-23
• Subjects: clinical prediction rule -- decision support techniques -- bronchiolitis; Pediatric respiratory diseases -- Periodicals; Pediatrics -- Periodicals; 618.922
• DOI: 10.1002/ppul.23663
• Languages: English
• ISSNs: 8755-6863

Abstract

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.