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.