WIP 74 - Factors Associated with Early Escalation of Care in Children Hospitalized with Bronchiolitis

Publication Number: WIP 74.7713

Braidy L. Megeff, Johns Hopkins All Children's Hospital, Saint Petersburg, FL, United States; John Morrison, Johns Hopkins All Children's Hospital, Apollo Beach, FL, United States

Background: Bronchiolitis is a leading cause of hospitalization in children < 2 years of age, most often for respiratory support. Many institutions limit the degree of support provided on the general pediatric inpatient unit, reserving high flow rates and non-invasive/invasive ventilation for the pediatric intensive care unit (PICU). Accurately determining which patients will require escalation of care necessitating PICU admission within the emergency room is difficult but may help with appropriate provision of limited personnel and ICU beds. Identifying factors associated with escalation of care within 12 hours of admission for bronchiolitis could improve triage and disposition of these patients; however, such factors remain poorly defined.

Objective: Determine if the level of respiratory support (defined as proportion of institutional maximum allowable flow rate for age) at time of admission in children hospitalized with bronchiolitis is associated with odds of early escalation to ICU care.

Design/Methods: We will perform a single center case control study of 285 patients age < 2 years admitted to our institution between 10/2020 and 10/2023 with bronchiolitis. Children admitted for a diagnosis other than bronchiolitis will be excluded. Data will be retrospectively collected from the electronic health record. Our primary predictor will be the highest proportion of institutional maximum allowable nasal cannula flow rate within the first 12 hours of admission (or immediately prior to PICU transfer, whichever is shorter). Our primary outcome is early escalation of care (i.e., transfer to PICU within 12 hours of admission). We will use standard descriptive statistics to summarize and compare demographic and clinical data between groups with and without early escalation. A conditional multivariate logistic-regression model will be used to estimate odds ratios and associated 95% confidence intervals. We plan to adjust for variables of age, initial vital signs, adjunctive therapies, positive viral testing, and time of day at admission. This study has been approved by the Johns Hopkins IRB.