• Dorothy Damore, Jonathan M Mansbach, Sunday Clark, Maria Ramundo, and Carlos A Camargo.
• Department of Emergency Medicine, New York Presbyterian Hospital/Weill Cornell Medial Center, New York, NY, USA. djt2001@med.cornell.edu
• Acad Emerg Med. 2008 Oct 1;15(10):887-94.

ObjectivesThe authors sought to identify predictors of intensive care unit (ICU) admission among children hospitalized with bronchiolitis for > or =24 hours.MethodsThe authors conducted a prospective cohort study during two consecutive bronchiolitis seasons, 2004 through 2006, in 30 U.S. emergency departments (EDs). All included patients were aged <2 years and had a final diagnosis of bronchiolitis. Regular floor versus ICU admissions were compared.ResultsOf 1,456 enrolled patients, 533 (37%) were admitted to the regular floor and 50 (3%) to the ICU. Comparing floor and ICU admissions, multivariate ED predictors of ICU admission were age <2 months (26% vs. 53%; odds ratio [OR] = 4.1; 95% confidence interval [CI] = 2.1 to 8.3), an ED visit the past week (25% vs. 40%; OR = 2.2; 95% CI = 1.1 to 4.4), moderate/severe retractions (31% vs. 48%; OR = 2.6; 95% CI = 1.3 to 5.2), and inadequate oral intake (31% vs. 53%; OR = 3.3; 95% CI = 1.6 to 7.1). Unlike previous studies, no association with male gender, socioeconomic factors, insurance status, breast-feeding, or parental asthma was found with ICU admission.ConclusionsIn this prospective multicenter ED-based study of children admitted for bronchiolitis, four independent predictors of ICU admission were identified. The authors did not confirm many putative risk factors, but cannot rule out modest associations.

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