CHICAGO — Age less than 2 months and male gender were significant independent predictors of relapse in children after ED treatment for bronchiolitis, according to a secondary analysis of a prospective, observational multicenter cohort of 1,459 patients.
Almost one in five children relapsed within 2 weeks of discharge from the ED—a number comparable with relapse rates observed in children with asthma, Dr. Muhammad Waseem and colleagues reported at the annual meeting of the American College of Emergency Physicians.
Bronchiolitis is a common condition in children younger than 2 years—yet there is little, if any, evidence for physicians and parents about which children will have a worsening of their disease after being discharged home from the ED, Dr. Waseem said.
Children younger than 2 years (median 6 months) were enrolled at 30 sites in 15 states during two consecutive bronchiolitis seasons: Dec. 1, 2004, through March 31, 2005, and Dec. 1, 2005, through March 31, 2006. A total of 58% of the Multicenter Airway Research Collaboration cohort's children were male; 38% of patients were white, 31% were black, 26% were Hispanic, and 4% were categorized as other.
Among the 1,243 (85%) patients for whom telephone follow-up was completed at 2 weeks, 722 (58%) were discharged home and met the analysis criteria.
Among the 717 children with relapse data, 121 (17%) had a post-ED relapse event defined as any urgent visit to an ED or clinic for worsening of bronchiolitis during the 2-week follow-up period.
Using a more restrictive definition of worsening of bronchiolitis that included changing the child's medication or hospital admission, 80 children (11%) relapsed, the researchers reported.
Children who had a post-ED relapse event were significantly more likely than those who did not to be younger than 2 months (11% vs. 6%) and male (70% vs. 57%), said Dr. Waseem, an attending physician in emergency medicine at Lincoln Medical and Mental Health Center, Bronx, N.Y., and an associate professor in emergency medicine at Cornell University Medical School, New York.
The study was supported by the Thrasher Research Fund and a data analysis grant from Merck & Co.
Coauthors Dr. Jonathan M. Mansbach and Dr. Carlos A. Camargo disclosed having received investigator-initiated research grants from AstraZeneca PLC, MedImmune Inc., and Merck.