The Science Journal of the American Association for Respiratory Care

2001 OPEN FORUM Abstracts

USEOF A BRONCHIOLITIS SYMPTOM SCORING SYSTEM IN INFANTS

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Julie Ballard RRT BS, QCAT Members, and John Salyer RRT MBA FAARC. RespiratoryCare Services, Primary Children?s Medical Center and School of Medicine, Universityof Utah, Salt Lake City, UT.

Introduction: Our multidisciplinary Quality Care Assessment Team (QCAT)evaluates and recommends appropriate respiratory care for non-ICU bronchiolitispts (Respir Care 1998;43:867). They utilize a respiratory symptom based bronchiolitisscoring system that helps to determine effectiveness of care and severity ofillness. This system evaluates and assigns scores to each pt based on the respiratoryrate, breath sounds and retractions. Scores are classified 0-1 normal, 2-3 milddistress, 4-6 moderate distress, and 7-9 severe distress. Additionally, alldischarges are classified to a severity category (1 through 4, lowest to highest)based on diagnostic and procedural coding using All Patient Refined ? DiagnosisRelated Group, Severity of Illness (SOI). We sought to test whether there wasan association between these two severity scoring systems and other indicatorsof severity, such as O2 requirement, LOS and resource consumption.

Methods:Inclusion criteria were 1) age < 24 months 2) non-ICU 3) dx of bronchiolitisand 4) documentation of at least 1 bronchiolitis score. We excluded any ptsreceiving O2 by mask or blow-by. The study period was Oct-2000 throughApr-2001. Most of these pts were admitted through the ED, but only the initialscore obtained after floor admission was used. Length of Stay (LOS) in hours,costs, charges, and SOI were obtained from our hospital case-mix database. Bronchiolitisscores and O2 requirements were obtained from retrospective chartreview. Liter flow was adjusted as needed to keep pulse oximetry levels >88%. Categorical data were tested with Chi square and means testing was ANOVAwith significance set at P < 0.05.

Results:512 pts met the criteria for the study. Seven pts were excluded because of incompletedata and 12 because they received O2 by mask or blow-by, leaving493 pts in our study. The initial score was obtained on average 5.4 hrs afterfloor admission.

Initial scorenLOS (hours)Costs($)Charges ($)O2 (L/m)SOI-1 CountSOI-2 CountSOI-3 CountSOI-4 Count
0-12454255536850.53111210
2-32327779376953720.5883113297
4-6 2162133654864 0.777011131 4
7-10131789511,4491.187662

LOS, Costs, Chargesand O2 are mean values and all yield ANOVA P < 0.05 SOI vs bronchiolitis score Chi SquareP-Value = 0.13

Conclusion:There appears to be an association between the bronchiolitis score and resourceconsumption. The slight drop in costs and charges between the mild and moderatelevels are probably due to scoring limitations, which include looking only atrespiratory symptoms. The most compelling evidence of the effectiveness of thebronchiolitis score is the trend upward in O2 requirements with increasingscores, since the score, as well as O2 requirements really focuseson respiratory symptoms. The inconsistent association with the SOI scores isdisappointing and probably explained by the fact that the SOI looks at diagnoses,co-morbidities, procedures, and age, and includes no symptom measures. We havebeen using the bronchiolitis score since 1997 and find it very helpful in clinicaldecision making.

 

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