The Science Journal of the American Association for Respiratory Care

2004 OPEN FORUM Abstracts

A COMPARISON OF RESPIRATORY SYNCYTIAL VIRUS (RSV) POSITIVE BRONCHIOLITIS PATIENT OUTCOMES: TWO SEASONS IN REVIEW.

Kim Bennion BS RRT and Julie Ballard BS RRT, Primary Children’s Medical Center, Salt Lake City, Utah.

Introduction:
Our facility is a 232-bed pediatric, tertiary, teaching facility. We have been tracking outcomes of bronchiolitis patients (pt) for the past seven seasons defined as Nov. 1-April 30. It was our impression that RSVstrain variances may produce varying pt outcomes from season to season. Co-morbidities (congenital heart disease, chronic lung disease, immuno-compromised pts & neuromuscular diseases) and pts with a history of prematurity ( < 38 weeks) have been identified as conditions that can complicate the course of bronchiolitis. We sought to test the hypothesis that RSV strain variance may vary from season to season & may produce different pt outcomes in the routine bronchiolitis pts.

Methods:
Data were retrospectively extracted from our hospital databases. Inclusion criteria were:

(1) pts < 2 years of age, (2) admitted to the hospital during the 02-03 or 03-04 seasons, and (3) had a positive test for RSV as determined via nasopharyngeal secretions. Pts were excluded who had a co-morbidity as listed above or a history of prematurity as we sought to remove variables that might otherwise effect pt. outcomes. We compared Severity of Illness (SOI) scores which are procedural & co-morbidity driven scores that are assigned after pt discharge. The SOI ranges from 0-4 score with 1 being the least and 4 being the most severe. Having initially excluded pts with significant co-morbidities, we felt the SOI would be more reflective of procedures done hypothesizing that sicker pts might require more interventions/procedures. Mechanical ventilation (MV) is defined as those pts requiring intubation for invasive ventilation (IV) & those ventilated without intubation, noted here as non-invasive ventilation (NIV).

Results:
A total of 764 pts met the criteria. Statistical analysis included T-test for continuous data and Chi square analysis for nominal data. Results are reported by season in Table One.

Table One: A Comparison of RSV Positive Bronchiolitis Patients Over Two Seasons

  2002-2003 Season 2003-2004 Season P-value
Total # Pts 267 497 ----
Mean # Txs/Pt 3.0 1.8 < 0.01
Mean # NPS/Pt 8.9 6.8 < 0.01
Initial Mean O2 Need (L/m) 0.61 0.64 0.73
# (%) Pts in ICU 8 (3) 35 (7) 0.02
# (%) Pts on IV 6 (2) 17 (3) 0.37
# (%) Pts on NIV 21 (8) 36 (7) 0.76
LOS (days) 3.3 3.3 0.69
Mean Cost/Case $4723 $4187 0.11

Cost/case is inflation adjusted to 2004 dollars.

Discussion: SOI was statistically significant (P= 0.04) when the two seasons were compared as the percent of Level 3 pts doubled (6% to 12 %) from the 2002-2003 to 2003-2004 season. The number of pts in the ICU increased during the 2003-2004 season probably due more to a change in practice. Pts were kept on the floor for NIV during the 2002-2003 but were moved to the ICU for NIV during the 2003-2004 season if an ICU bed was available. It is our conclusion that there does not appear to be a difference in resource consumption (# txs/pt, # NPS/pt & # (%) pts in ICU) when comparing RSV strains from the last two seasons. More study is needed before conclusions can be made.

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