Prediction of the severity and length of hospital stay in infants with acute bronchiolitis using the severity score

Yeongsang Jeong; Ji Hyen Hwang; Ji Yoon Kwon; Jeonghee Shin; Jung Hyun Kwon; Kyungdo Han; Won Hee Seo; Ji Tae Choung

doi:10.4168/aard.2016.4.6.429

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Jeong, Hwang, Kwon, Shin, Kwon, Han, Seo, and Choung: Prediction of the severity and length of hospital stay in infants with acute bronchiolitis using the severity score

Original Article

Allergy, Asthma & Respiratory Disease 2016; 4(6): 429-435.

Published online: 30 November 2016

DOI: https://doi.org/10.4168/aard.2016.4.6.429

Prediction of the severity and length of hospital stay in infants with acute bronchiolitis using the severity score

Yeongsang Jeong¹, Ji Hyen Hwang¹, Ji Yoon Kwon¹, Jeonghee Shin¹, Jung Hyun Kwon¹, Kyungdo Han², Won Hee Seo¹

, Ji Tae Choung¹

¹Department of Pediatrics, Korea University College of Medicine, Seoul, Korea.

²Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Correspondence to: Won Hee Seo. Department of Pediatrics, Korea University Ansan Hospital, 123 Jeokgeum-ro, Danwon-gu, Ansan 15355, Korea. Tel: +82-31-412-5096, Fax: +82-31-405-8591, wonny508@korea.ac.kr

Received 15 July 2016 Revised 1 August 2016 Accepted 30 August 2016

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/).

Abstract

Purpose

This study aimed to evaluate the clinical factors that could influence the length of hospital stay (LHS) of infants with acute bronchiolitis using the bronchiolitis severity score (BSS).

Methods

The medical records of 105 infants aged 0–12 months with acute bronchiolitis who were admitted to a tertiary hospital between December 2014 and May 2015 were reviewed. The BSS was composed 5 factors, namely general condition, wheezing, chest retraction, respiration rate, and peripheral oxygen saturation, which were evaluated at admission. In addition, the age of the infants, LHS, body weight, birth history, familial history, laboratory test result, chest X-ray, and treatment modalities were reviewed. Subjects were classified into 3 groups according to their BSS, and logistic regression analysis was used to identify the association of the BSS with longer LHS.

Results

Among subjects, 62 were studied. Their mean LHS and age were 5.5±2.0 days and 3.9±2.7 months, respectively. Twelve infants were classified as mild (20.3%), 43 as moderate (68.8%), and 7 as severe (10.9%). Venous blood gas pH value and white blood cell count were the best predictors of disease severity. The LHS was associated with the BSS, age, body weight and pCO₂ by venous blood gas analysis (P<0.05).

Conclusion

The LHS was associated with the BSS, age, body weight, and pCO₂ by venous blood gas analysis at admission. The BSS could be a useful tool to predict disease severity and decide treatment strategies for infants with acute bronchiolitis who have no known risk factors.

Keywords: Bronchiolitis, Hospitalization, Infant, Hospital stay, Severity

Figures and Tables

Fig. 1

Percentage of oxygen therapy and use of systemic corticosteroid in each groups by bronchial severity score (BSS). BSS: mild, 0–5; moderate, 6–10; severe, >10.

Table 1

Bronchiolitis severity score (BSS)⁸

Clinical index	Score
Clinical index	0	1	2	3
General appearance	Quite, sleeping	Crying when touched, but easy to console	Moderately irritable, difficult to console	Extremely irritable, lethargic, poor feeing
Wheezing	No crepitation, no wheezing	Diffuse crepitation or terminal expiratory wheezing	Entire expiratory wheezing	Diffuse inspiratory wheezing with or without expiratory wheezing
Chest retraction	None	Mild, intercostal retraction	Moderate, sternal retraction	Severe (severe retraction with nasal flaring)
Respiratory rate (per min)	< 40	40–55	56–65	> 65
SpO₂ (%)	> 96	93–95	90–92	< 90

SpO₂, peripheral oxygen saturation.

BSS: mild, 0–5; moderate, 6–10; severe, >10.

Table 2

Demographic characteristics of the subjects (n=62)

Characteristic	Value
Age (mo)	3.9±2.7
Boys	43 (69.4)
Body weight at birth (kg)	3.3±0.4
Body weight at admission (kg)	7.1±1.9
Height (cm)	63.9±7.3
Use of systemic corticosteroid treatment	33 (53.2)
Duration of steroid treatment (day)	5.0±2.0
Oxygen therapy	27 (43.6)
Duration of oxygen therapy (day)	3.7±2.2

Values are presented as mean±standard deviation or number (%).

Table 3

Demographic characteristics of 3 groups by bronchiolitis severity score (BSS)

Characteristic	Group
Characteristic	Mild (n = 12)	Moderate (n = 43)	Severe (n = 7)
Age (mo)	4.6 ± 3.1	3.8 ± 2.6	3.5 ± 2.1
Boys	7 (58.3)	30 (69.8)	5 (71.4)
Body weight at birth (kg)	3.1 ± 0.4	3.3 ± 0.4	3.5 ± 0.2
Body weight at admission (kg)	7.4 ± 1.9	7.1 ± 1.9	7.2 ± 1.7
Height (cm)	64.0 ± 6.7	63.8 ± 7.4	64.3 ± 7.0
Use of systemic corticosteroid treatment	1 (8.3)	26 (60.5)	6 (85.7)
Oxygen therapy	1 (8.3)	20 (46.5)	6 (85.7)

Values are presented as mean±standard deviation or number (%).

BSS: mild, 0–5; moderate, 6–10; severe, >10.

Table 4

Comparison of clinical characteristics between mild, moderate, and severe group

Characteristic	BSS group		P-value
Characteristic	Mild and moderate (n = 55)	Severe (n = 7)	P-value
Hospital length of stay (day)	5.3 ± 1.9	7.1 ± 2.2	0.02^*
Age (mo)	4.0 ± 2.7	3.5 ± 2.3	0.66
Body weight at birth (kg)	3.2 ± 0.4	3.5 ± 0.2	0.15
Body weight at admission (kg)	7.1 ± 1.9	7.2 ± 1.9	0.91
Height (cm)	63.8 ± 7.4	64.3 ± 7.5	0.88
VBGA pH	7.35 ± 0.03	7.32 ± 0.05	0.01^*
VBGA pCO₂ (mmHg)	44.4 ± 7.4	47.2 ± 10.4	0.36
WBC (/µL)	9,395.8 ± 3,335.3	13,992.9 ± 7,249.2	0.01^*
CRP (mg/dL)	0.6 ± 1.0	0.6 ± 0.6	0.98

Values are presented as mean±standard deviation.

BSS, bronchiolitis severity score; VBGA, venous blood gas analysis; pCO₂, partial pressure of carbon dioxide; WBC, white blood cell count; CRP, C-reactive protein.

BSS: mild and moderate, ≤10; severe, >10.

^*P<0.05.

Table 5

Comparison of clinical characteristics between groups sorted by hospital length of stay

Characteristic	Hospital length of stay (day)		P-value
Characteristic	<7 (n=47)	≥7 (n=15)	P-value
BSS	7.1 ± 2.2	9.0 ± 2.2	0.01^*
Age (mo)	4.4 ± 2.6	2.5 ± 2.4	0.02^*
Bodyweight at birth (kg)	3.2 ± 0.4	3.4 ± 0.4	0.12
Bodyweight at admission (kg)	7.4 ± 1.7	6.3 ± 2.1	0.04^*
Height (cm)	64.9 ± 7.2	60.9 ± 7.1	0.07
VBGA pH	7.35 ± 0.04	7.33 ± 0.02	0.06
VBGA pCO₂ (mmHg)	43.0 ± 5.6	49.8 ± 11.0	< 0.01^*
WBC (/µL)	10,254.7 ± 4,430.0	8,850.0 ± 2,953.0	0.26
CRP (mg/dL)	0.6 ± 1.0	0.5 ± 0.8	0.62

Values are presented as mean±standard deviation.

BSS, bronchiolitis severity score; VBGA, venous blood gas analysis; pCO₂, partial pressure of carbon dioxide; WBC, white blood cell count; CRP, C-reactive protein.

BSS: mild and moderate, ≤10; severe, >10.

^*P<0.05.

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ORCID iDs: Won Hee Seo
https://orcid.org/http://orcid.org/0000-0001-5625-5131
Similar articles

Prediction of the severity and length of hospital stay in infants with acute bronchiolitis using the severity score

Abstract

Purpose

Methods

Results

Conclusion

Figures and Tables

Fig. 1

Percentage of oxygen therapy and use of systemic corticosteroid in each groups by bronchial severity score (BSS). BSS: mild, 0–5; moderate, 6–10; severe, >10.

Table 1

Bronchiolitis severity score (BSS)8

Table 2

Demographic characteristics of the subjects (n=62)

Table 3

Demographic characteristics of 3 groups by bronchiolitis severity score (BSS)

Table 4

Comparison of clinical characteristics between mild, moderate, and severe group

Table 5

Comparison of clinical characteristics between groups sorted by hospital length of stay

References

Bronchiolitis severity score (BSS)⁸