Now a days, there seems to be a clinical predictor “rule” for just about everything. The most recent comes from a paper titled Clinical predictors of admission in infants with acute bronchiolitis.
This study is from a pediatric ED in London where they retrospectively reviewed clinical records of 449 infants (age, <12 months; mean age, 23 weeks; 66% male) who presented with symptoms of acute bronchiolitis during a 12-month period. A total of 163 infants (36%) were admitted to the hospital, and 29 potential predictors of admission were examined.
They found the best predictors of admission were age, respiratory rate, heart rate, O2 sats, and duration of symptoms. From this they developed a clinical risk scoring system using the area under the receiver operating characteristic curve to determine the weight given for each predictor.
The following predictors of admission were assigned 1 point each:
Symptom duration <5 days
Respiratory rate ≥50
Heart rate ≥155
RA O2 sats <97%
age <18 weeks
A clinical risk score ≥3 predicted need for admission (sensitivity, 74%; specificity, 77%; positive and negative predictive values, 67% and 83%, respectively) (The authors do point out that the patient's clinical condition, social support system, and comorbid medical conditions also play an important role in determining whether to admit a child with bronchiolitis.)
This looks to helpful and hopefully be validated in a prospective study in the near future. My take home is that duration of illness, resp rate, heart rate, O2 sat,
age, social support, and comorbid conditions are the most important part of the evaluation. -