Bronchiolitis is common in infants, and deciding whether or not to admit these patients can be difficult in the emergency department (ED). Researchers at a large, urban academic center in the United Kingdom sought to identify clinical predictors of hospital admission in infants presenting with bronchiolitis and to devise a clinical risk scoring system in this population. The authors retrospectively examined the clinical records of 449 infants that presented with acute bronchitis over a 1-year period. Of these patients, 163 (36%) were admitted to the hospital. A total of 29 potential risk predictors were evaluated, and the most accurate predictors of hospital admission were age, duration of symptoms, heart rate, respiratory rate, and oxygen saturation. Predictors with incomplete data sets or that were objective in nature, were excluded. The authors then took these predictors and developed a scoring system assessing the need for admission. The authors assigned the following predictors 1 point each: age < 18 weeks, symptom duration < 5 days, heart rate 155 beats/min or greater, respiratory rate 50 breaths/min or greater, and oxygen saturation < 97%. A clinical risk score of 3 or more resulted in a sensitivity of 74% for predicting admission (specificity 77%, positive predictive value 67%, and negative predictive value 83%).
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© 2011 Published by Elsevier Inc.