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.