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Viral lower respiratory tract infections—strict admission guidelines for young children can safely reduce admissions
Viral lower respiratory tract infection (VLRTI) is the most common cause of hospital admission among small children in high-income countries. Guidelines to identify children in need of admission are lacking in the literature. In December 2012, our hospital introduced strict guidelines for admission....
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| Published in: | European journal of pediatrics 2021-08, Vol.180 (8), p.2473-2483 |
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| container_title | European journal of pediatrics |
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| creator | Havdal, Lise Beier Nakstad, Britt Fjærli, Hans Olav Ness, Christian Inchley, Christopher |
| description | Viral lower respiratory tract infection (VLRTI) is the most common cause of hospital admission among small children in high-income countries. Guidelines to identify children in need of admission are lacking in the literature. In December 2012, our hospital introduced strict guidelines for admission. This study aims to retrospectively evaluate the safety and efficacy of the guidelines. We performed a single-center retrospective administrative database search and medical record review. ICD-10 codes identified children < 24 months assessed at the emergency department for VLRTI for a 10-year period. To identify adverse events related to admission guidelines implementation, we reviewed patient records for all those discharged on primary contact followed by readmission within 14 days. During the study period, 3227 children younger than 24 months old were assessed in the ED for VLRTI. The proportion of severe adverse events among children who were discharged on their initial emergency department contact was low both before (0.3%) and after the intervention (0.5%) (
p
=1.0). Admission rates before vs. after the intervention were for previously healthy children > 90 days 65.3% vs. 53.3% (
p |
| doi_str_mv | 10.1007/s00431-021-04057-4 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8285352</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2511246240</sourcerecordid><originalsourceid>FETCH-LOGICAL-c498t-658516441323641d4f6d90626f4383c58ebaf952350ea6525eaa62a39e04c7e43</originalsourceid><addsrcrecordid>eNp9kb1uFDEUhS1ERDYLL0ABlmhoBvw_doOEohCQIqUBWsvx3Nk48tqLPRO0HQ-RJ-RJ8LL5AQoKy_L1d8_18UHoOSVvKCH920qI4LQjrC1BZN-JR2hBBWcdJb16jBaEC9IpaswhOqr1irQmQ_UTdMi55oL1fIGuv4biIo75OxRcoG7accpli6fi_IRDGsFPIaf688dNnUpoNTesQ62thldzGCCGBBWPueBtntMK-8sQhwIJe5dwdSPEbRMeZg8PnfUpOhhdrPDsdl-iLx9OPh9_7M7OTz8dvz_rvDB66pTUkiohKGdcCTqIUQ2GKKZG0Rx4qeHCjUYyLgk4JZkE5xRz3AARvgfBl-jdXnczX6xh8JCar2g3Jaxd2drsgv37JoVLu8rXVjMteRNeopd7AV9CnUKyKRdnKdGSWUOV6Rvx-nZEyd9mqJNtJj3E6BLkuVomKWVCMUEa-uof9CrPJbUPaJRkVEutdxS7G5lrLTDeP5cSuwve7oO3LXj7O3i7M_riT6P3LXdJN4Dvgdqu0grKw-z_yP4CMym6qg</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2552185880</pqid></control><display><type>article</type><title>Viral lower respiratory tract infections—strict admission guidelines for young children can safely reduce admissions</title><source>NORA - Norwegian Open Research Archives</source><source>Springer Nature</source><creator>Havdal, Lise Beier ; Nakstad, Britt ; Fjærli, Hans Olav ; Ness, Christian ; Inchley, Christopher</creator><creatorcontrib>Havdal, Lise Beier ; Nakstad, Britt ; Fjærli, Hans Olav ; Ness, Christian ; Inchley, Christopher</creatorcontrib><description>Viral lower respiratory tract infection (VLRTI) is the most common cause of hospital admission among small children in high-income countries. Guidelines to identify children in need of admission are lacking in the literature. In December 2012, our hospital introduced strict guidelines for admission. This study aims to retrospectively evaluate the safety and efficacy of the guidelines. We performed a single-center retrospective administrative database search and medical record review. ICD-10 codes identified children < 24 months assessed at the emergency department for VLRTI for a 10-year period. To identify adverse events related to admission guidelines implementation, we reviewed patient records for all those discharged on primary contact followed by readmission within 14 days. During the study period, 3227 children younger than 24 months old were assessed in the ED for VLRTI. The proportion of severe adverse events among children who were discharged on their initial emergency department contact was low both before (0.3%) and after the intervention (0.5%) (
p
=1.0). Admission rates before vs. after the intervention were for previously healthy children > 90 days 65.3% vs. 53.3% (
p
<0.001); for healthy children ≤ 90 days 85% vs. 68% (
p
<0.001); and for high-risk comorbidities 74% vs. 71% (
p
=0.5).
Conclusion
: After implementation of admission guidelines for VLRTI, there were few adverse events and a significant reduction in admissions to the hospital from the emergency department. Our admission guidelines may be a safe and helpful tool in the assessment of children with VLRTI.
What is Known:
• Viral lower respiratory tract infection, including bronchiolitis, is the most common cause of hospitalization for young children in the developed world. Treatment is mainly supportive, and hospitalization should be limited to the cases in need of therapeutic intervention.
• Many countries have guidelines for the management of the disease, but the decision on whom to admit for inpatient treatment is often subjective and may vary even between physicians in the same hospital.
What is New:
• Implementation of admission criteria for viral lower respiratory tract infection may reduce the rate of hospital admissions without increasing adverse events.</description><identifier>ISSN: 0340-6199</identifier><identifier>EISSN: 1432-1076</identifier><identifier>DOI: 10.1007/s00431-021-04057-4</identifier><identifier>PMID: 33834273</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Adverse events ; Bronchiolitis ; Bronchopneumonia ; Child ; Child, Preschool ; Children ; Emergency medical care ; Emergency Service, Hospital ; Hospitalization ; Humans ; Infant ; Infections ; Medicine ; Medicine & Public Health ; Original ; Original Article ; Patient Discharge ; Pediatrics ; Respiratory tract diseases ; Respiratory tract infection ; Retrospective Studies</subject><ispartof>European journal of pediatrics, 2021-08, Vol.180 (8), p.2473-2483</ispartof><rights>The Author(s) 2021. corrected publication 2022</rights><rights>2021. The Author(s).</rights><rights>The Author(s) 2021. corrected publication 2022. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>info:eu-repo/semantics/openAccess</rights><rights>The Author(s) 2021</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c498t-658516441323641d4f6d90626f4383c58ebaf952350ea6525eaa62a39e04c7e43</citedby><cites>FETCH-LOGICAL-c498t-658516441323641d4f6d90626f4383c58ebaf952350ea6525eaa62a39e04c7e43</cites><orcidid>0000-0001-7429-8119 ; 0000-0002-6843-8100 ; 0000-0003-2066-7972</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,26546,27903,27904</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33834273$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Havdal, Lise Beier</creatorcontrib><creatorcontrib>Nakstad, Britt</creatorcontrib><creatorcontrib>Fjærli, Hans Olav</creatorcontrib><creatorcontrib>Ness, Christian</creatorcontrib><creatorcontrib>Inchley, Christopher</creatorcontrib><title>Viral lower respiratory tract infections—strict admission guidelines for young children can safely reduce admissions</title><title>European journal of pediatrics</title><addtitle>Eur J Pediatr</addtitle><addtitle>Eur J Pediatr</addtitle><description>Viral lower respiratory tract infection (VLRTI) is the most common cause of hospital admission among small children in high-income countries. Guidelines to identify children in need of admission are lacking in the literature. In December 2012, our hospital introduced strict guidelines for admission. This study aims to retrospectively evaluate the safety and efficacy of the guidelines. We performed a single-center retrospective administrative database search and medical record review. ICD-10 codes identified children < 24 months assessed at the emergency department for VLRTI for a 10-year period. To identify adverse events related to admission guidelines implementation, we reviewed patient records for all those discharged on primary contact followed by readmission within 14 days. During the study period, 3227 children younger than 24 months old were assessed in the ED for VLRTI. The proportion of severe adverse events among children who were discharged on their initial emergency department contact was low both before (0.3%) and after the intervention (0.5%) (
p
=1.0). Admission rates before vs. after the intervention were for previously healthy children > 90 days 65.3% vs. 53.3% (
p
<0.001); for healthy children ≤ 90 days 85% vs. 68% (
p
<0.001); and for high-risk comorbidities 74% vs. 71% (
p
=0.5).
Conclusion
: After implementation of admission guidelines for VLRTI, there were few adverse events and a significant reduction in admissions to the hospital from the emergency department. Our admission guidelines may be a safe and helpful tool in the assessment of children with VLRTI.
What is Known:
• Viral lower respiratory tract infection, including bronchiolitis, is the most common cause of hospitalization for young children in the developed world. Treatment is mainly supportive, and hospitalization should be limited to the cases in need of therapeutic intervention.
• Many countries have guidelines for the management of the disease, but the decision on whom to admit for inpatient treatment is often subjective and may vary even between physicians in the same hospital.
What is New:
• Implementation of admission criteria for viral lower respiratory tract infection may reduce the rate of hospital admissions without increasing adverse events.</description><subject>Adverse events</subject><subject>Bronchiolitis</subject><subject>Bronchopneumonia</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Children</subject><subject>Emergency medical care</subject><subject>Emergency Service, Hospital</subject><subject>Hospitalization</subject><subject>Humans</subject><subject>Infant</subject><subject>Infections</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Original</subject><subject>Original Article</subject><subject>Patient Discharge</subject><subject>Pediatrics</subject><subject>Respiratory tract diseases</subject><subject>Respiratory tract infection</subject><subject>Retrospective Studies</subject><issn>0340-6199</issn><issn>1432-1076</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>3HK</sourceid><recordid>eNp9kb1uFDEUhS1ERDYLL0ABlmhoBvw_doOEohCQIqUBWsvx3Nk48tqLPRO0HQ-RJ-RJ8LL5AQoKy_L1d8_18UHoOSVvKCH920qI4LQjrC1BZN-JR2hBBWcdJb16jBaEC9IpaswhOqr1irQmQ_UTdMi55oL1fIGuv4biIo75OxRcoG7accpli6fi_IRDGsFPIaf688dNnUpoNTesQ62thldzGCCGBBWPueBtntMK-8sQhwIJe5dwdSPEbRMeZg8PnfUpOhhdrPDsdl-iLx9OPh9_7M7OTz8dvz_rvDB66pTUkiohKGdcCTqIUQ2GKKZG0Rx4qeHCjUYyLgk4JZkE5xRz3AARvgfBl-jdXnczX6xh8JCar2g3Jaxd2drsgv37JoVLu8rXVjMteRNeopd7AV9CnUKyKRdnKdGSWUOV6Rvx-nZEyd9mqJNtJj3E6BLkuVomKWVCMUEa-uof9CrPJbUPaJRkVEutdxS7G5lrLTDeP5cSuwve7oO3LXj7O3i7M_riT6P3LXdJN4Dvgdqu0grKw-z_yP4CMym6qg</recordid><startdate>20210801</startdate><enddate>20210801</enddate><creator>Havdal, Lise Beier</creator><creator>Nakstad, Britt</creator><creator>Fjærli, Hans Olav</creator><creator>Ness, Christian</creator><creator>Inchley, Christopher</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>C6C</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><scope>3HK</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-7429-8119</orcidid><orcidid>https://orcid.org/0000-0002-6843-8100</orcidid><orcidid>https://orcid.org/0000-0003-2066-7972</orcidid></search><sort><creationdate>20210801</creationdate><title>Viral lower respiratory tract infections—strict admission guidelines for young children can safely reduce admissions</title><author>Havdal, Lise Beier ; Nakstad, Britt ; Fjærli, Hans Olav ; Ness, Christian ; Inchley, Christopher</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c498t-658516441323641d4f6d90626f4383c58ebaf952350ea6525eaa62a39e04c7e43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adverse events</topic><topic>Bronchiolitis</topic><topic>Bronchopneumonia</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Children</topic><topic>Emergency medical care</topic><topic>Emergency Service, Hospital</topic><topic>Hospitalization</topic><topic>Humans</topic><topic>Infant</topic><topic>Infections</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Original</topic><topic>Original Article</topic><topic>Patient Discharge</topic><topic>Pediatrics</topic><topic>Respiratory tract diseases</topic><topic>Respiratory tract infection</topic><topic>Retrospective Studies</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Havdal, Lise Beier</creatorcontrib><creatorcontrib>Nakstad, Britt</creatorcontrib><creatorcontrib>Fjærli, Hans Olav</creatorcontrib><creatorcontrib>Ness, Christian</creatorcontrib><creatorcontrib>Inchley, Christopher</creatorcontrib><collection>SpringerOpen</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>ProQuest Nursing and Allied Health Source</collection><collection>Neurosciences Abstracts</collection><collection>ProQuest - Health & Medical Complete保健、医学与药学数据库</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>ProQuest Family Health</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><collection>NORA - Norwegian Open Research Archives</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>European journal of pediatrics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Havdal, Lise Beier</au><au>Nakstad, Britt</au><au>Fjærli, Hans Olav</au><au>Ness, Christian</au><au>Inchley, Christopher</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Viral lower respiratory tract infections—strict admission guidelines for young children can safely reduce admissions</atitle><jtitle>European journal of pediatrics</jtitle><stitle>Eur J Pediatr</stitle><addtitle>Eur J Pediatr</addtitle><date>2021-08-01</date><risdate>2021</risdate><volume>180</volume><issue>8</issue><spage>2473</spage><epage>2483</epage><pages>2473-2483</pages><issn>0340-6199</issn><eissn>1432-1076</eissn><abstract>Viral lower respiratory tract infection (VLRTI) is the most common cause of hospital admission among small children in high-income countries. Guidelines to identify children in need of admission are lacking in the literature. In December 2012, our hospital introduced strict guidelines for admission. This study aims to retrospectively evaluate the safety and efficacy of the guidelines. We performed a single-center retrospective administrative database search and medical record review. ICD-10 codes identified children < 24 months assessed at the emergency department for VLRTI for a 10-year period. To identify adverse events related to admission guidelines implementation, we reviewed patient records for all those discharged on primary contact followed by readmission within 14 days. During the study period, 3227 children younger than 24 months old were assessed in the ED for VLRTI. The proportion of severe adverse events among children who were discharged on their initial emergency department contact was low both before (0.3%) and after the intervention (0.5%) (
p
=1.0). Admission rates before vs. after the intervention were for previously healthy children > 90 days 65.3% vs. 53.3% (
p
<0.001); for healthy children ≤ 90 days 85% vs. 68% (
p
<0.001); and for high-risk comorbidities 74% vs. 71% (
p
=0.5).
Conclusion
: After implementation of admission guidelines for VLRTI, there were few adverse events and a significant reduction in admissions to the hospital from the emergency department. Our admission guidelines may be a safe and helpful tool in the assessment of children with VLRTI.
What is Known:
• Viral lower respiratory tract infection, including bronchiolitis, is the most common cause of hospitalization for young children in the developed world. Treatment is mainly supportive, and hospitalization should be limited to the cases in need of therapeutic intervention.
• Many countries have guidelines for the management of the disease, but the decision on whom to admit for inpatient treatment is often subjective and may vary even between physicians in the same hospital.
What is New:
• Implementation of admission criteria for viral lower respiratory tract infection may reduce the rate of hospital admissions without increasing adverse events.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>33834273</pmid><doi>10.1007/s00431-021-04057-4</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0001-7429-8119</orcidid><orcidid>https://orcid.org/0000-0002-6843-8100</orcidid><orcidid>https://orcid.org/0000-0003-2066-7972</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | European journal of pediatrics, 2021-08, Vol.180 (8), p.2473-2483 |
| issn | 0340-6199 1432-1076 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8285352 |
| source | NORA - Norwegian Open Research Archives; Springer Nature |
| subjects | Adverse events Bronchiolitis Bronchopneumonia Child Child, Preschool Children Emergency medical care Emergency Service, Hospital Hospitalization Humans Infant Infections Medicine Medicine & Public Health Original Original Article Patient Discharge Pediatrics Respiratory tract diseases Respiratory tract infection Retrospective Studies |
| title | Viral lower respiratory tract infections—strict admission guidelines for young children can safely reduce admissions |
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