WIP 31 - Development of a Validated Bronchiolitis Score Utilizing Objective Criteria for Assessing Severity and Guiding De-escalation in Pediatric Patients.

Publication Number: WIP 31.7446

Mary K. Vetter, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, United States; Chinyere O'Connor, UTHealth Houston, Houston, TX, United States; Alvaro Coronado Munoz, The Children's Hospital at Montefiore, New York, NY, United States; Konstantinos Boukas, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, United States

Background: Acute bronchiolitis is a common cause of admission to the pediatric intensive care unit (PICU) for ICU-level respiratory support (ILRS). ILRS typically includes high flow nasal cannula (HFNC) and non-invasive positive pressure ventilation (NIPPV). There is controversial evidence in the literature on the utility of these ILRS modalities in reducing overall hospitalization. Bronchiolitis scores can help stratify illness severity and guide the de-escalation of respiratory support. However, existing scoring systems, such as the Bronchiolitis Severity Score (BSS), have several pitfalls, including inadequate validity data and poor interobserver reliability due to inclusion of subjective markers which creates bias. Objective, non-invasive measures such as the transcutaneous carbon dioxide (TcCO2), oxygen saturation (SpO2), and fraction of inspire oxygen (FiO2) can improve reliability in measuring bronchiolitis illness severity and facilitate a well-informed de-escalation plan.

Objective: To validate a tool that incorporates objective measures—TcCO2, FiO2, and SpO2— to better discriminate bronchiolitis patients with increased illness severity and identify patients ready for de-escalation from ILRS in the PICU.

Design/Methods: This prospective, observational, cohort study includes patients under the age of 2 admitted to a tertiary PICU between October 2023 and October 2024. Inclusion criteria consist of a diagnosis of bronchiolitis in patients receiving HFNC or NIPPV. Patients with congenital heart disease, home respiratory support, or culture positive bacterial infection were excluded. Data were collected in RedCAP and included demographics, TcCO2, SpO2, FiO2, and BSS within the first 72hrs of admission. Outcome measures include length of ILRS, length of PICU and hospital stay. We will assess predictive ability with receiver operator characteristic curves and perform spearman correlation and comparative analysis to evaluate differences between classifications by our tool and the BSS. Preliminary analysis of 48 patients is currently ongoing and will be finalized by February 2025.