Objectives & Background Bronchiolitis is a common diagnosis in patients presenting over the winter months. Predicting early in the patient journey the need for continued observation may improve patient flow and reduce crowding. In this study we aimed to assess the correlation between guideline derived severity of illness and initial acuity with outcome.
Methods Data on 100 patients who presented to our Children's Emergency Department with a diagnosis of bronchiolitis between September 2012 and June 2013 was analysed (data was also being used for an international study on outcomes of bronchiolitis). Severity of illness (via local guidance), initial POPS (Paediatric Observation Priority Score) and patient disposition was analysed.
Results 4 patients were excluded due to insufficient data, 14/96 had severity documented by the clinician and 96/96 had severity derived based on local guidelines. Figure 1 demonstrates POPS scores at the three levels of severity. Excluding patients who represented, Pearson's correlation between POPS and percentage discharged/admitted was significant (p=0.002) with r2 value of 0.72.
Conclusion In this small sample initial acuity (via POPS) demonstrates an association with patient disposition and bronchiolitis severity grading. It is noted the confidence intervals are large, potentially due to an insufficient sample size or large heterogeneity presenting features of bronchiolitis. We also note generally good agreement between a clinician's subjective opinion of severity and guideline derived severity. There is the potential for POPS to reduce cognitive error when there is a discrepancy between these assessments.⇓
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