The Science Journal of the American Association for Respiratory Care

2004 OPEN FORUM Abstracts

DO DIFFERENT CAUSATIVE AGENTS PRODUCE DIFFERENT BRONCHIOLITIS PATIENT OUTCOMES? A PILOT STUDY.

Kim Bennion BS RRT & 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 monitoring outcomes of bronchiolitis patients (pt) for the past seven seasons (defined as Nov. 1-April 30). Co-morbidities (congenital heart disease, chronic lung disease, immunocompromised pts & neuromuscular diseases) and/or a history of prematurity (< 38 weeks) have been identified as conditions that can complicate the course of bronchiolitis. It has been our impression that different causative agents produce varying pt outcomes.

Methods:
Data were retrospectively extracted from hospital databases. Inclusion criteria were: (1) pts < 2 years of age, (2) admitted to the hospital during the 02-03 or 03-04 seasons with any diagnosis of bronchiolitis, and (3) respiratory culture obtained for respiratory syncytial virus (RSV), adenovirus (AV), influenza A (IA), influenza B (IB) &/or parainfluenza (PF) obtained via nasopharyngeal suction (NPS). We sought to test our assumption about causative agents in routine bronchiolitis pts (no co-morbidities as described above or history of prematurity). Inhaled medication treatments (tx) included albuterol, xopenex &/or epinephrine. We reviewed causative agents in regard to txs/pt, initial oxygen need, nasopharyngeal suction (NPS) events per pt, pts in the intensive care unit (ICU), pts on mechanical ventilation (MV) or non-invasive ventilation (NIV), length of stay (LOS) & cost/case.

Results:
1524 pts met the initial criteria with 297 omitted for co-morbidities &/or prematurity. Another 77 pts were excluded for having had no respiratory viral panel done. Four pts were positive for two agents (1 RSV/PF, 1 RSV/AV & 2 RSV/IA), & 233 pts had negative (NEG) results for bronchiolitis causative agents for which we test. This left us with 1150 pts & 1154 viral panel studies. Although we test for haemophilus influenza, no pts were positive for this organism. Statistical analysis included ANOVA with multiple comparison post-hoc analysis for continuous data & Chi square analysis for nominal data. Results are reported in Table One.

Table One: Outcomes of Bronchiolitis Patients With Different Causative Agents

  RSV AV IA IB PF NEG P-value
# Pts. 817 9 56 4 35 233 ---
Mean #Txs/Pt 2.3 8.2 1.7 3.3 3.1 2.9 < 0.01
Initial O2 (LPM) 0.64 0.50 0.69 0.18 0.44 0.59 0.68
Mean # NPS/Pt 7.6 18.4 6.0 6.8 8.6 6.9 < 0.01
# (%) ICU Pts 60 (7) 1 (11) 4 (7) 0 (0) 0 (0) 9 (4) 0.24
# (%) Pts on MV/NIV 86 (11) 2 (22) 2 (4) 0 (0) 2 (6) 11(5) 0.03
LOS Median Days 3 5 2 2 2 2 0.27
Median Cost/Case $3120 $5218 $2609 $2272 $2499 $3017 0.87

Discussion: It was our observation that AV bronchiolitis pts are generally sicker and require an increased consumption of resources. Post-hoc comparison showed significance in mean number of txs & NPS events per pt between AV & the other agents. Chi square analysis showed significance in pts on MV/NIV. Statistical significance was not reached for initial O2 need, number of ICU pts, LOS or cost/case. We recognize that there were probably not enough pts to study and too much scatter in our results in the areas lacking statistical significance; therefore, several corporate databases are being merged to increase the number of pts to study where we will again test the hypothesis.

You are here: RCJournal.com » Past OPEN FORUM Abstracts » 2004 Abstracts » DO DIFFERENT CAUSATIVE AGENTS PRODUCE DIFFERENT BRONCHIOLITIS PATIENT OUTCOMES? A PILOT STUDY.