An assessment of severity of acute bronchiolitis using bronchiolitis severity score and its relation to serum sodium level in children attending Alexandria University Hospital

Abstract

Background Acute viral bronchiolitis is a significant cause of respiratory morbidity globally. Acute bronchiolitis is a clinical diagnosis based on the clinical judgment of the treating physician. Consequently, management strategies for acute bronchiolitis have great variability. Therefore, valid objective, evidence-based assessment tools were needed to help assess the severity of the illness, therefore reducing variation in management plans and standardizing care. Aim The present work aims to assess the validity of the use of bronchiolitis severity score (BSS) and serum sodium level in predicting the severity of acute bronchiolitis and the relation between them in children attending Alexandria University Children’s Hospital. Patients and methods The study was a comparative cross-sectional study of 131 children clinically diagnosed with acute bronchiolitis, from 1 month to 2 years of age, who presented to the Emergency Department of Alexandria University Children’s Hospital. Measurement of each patient’s BSS and serum sodium level was done on presentation in triage. Admitted and nonadmitted patients were followed up. Longer length of hospital stay and Pediatric Intensive Care Unit (PICU) admission were considered indicators of increased severity of the disease and worse outcomes. Results There was a male predominance and the median age of the studied patients was 3 months. On the basis of BSS, acute bronchiolitis was classified as mild in 19 (14.5%) cases, moderate in 79 (60.3%), and severe in 33 (25.2%). Hyponatremia at presentation was present in 20 (15.2%) cases. Increased severity, as determined by BSS, was statistically significantly associated with higher rates of admissions, longer hospital stays, and increased incidence of PICU hospitalization. There was no statistically significant difference between the hyponatremic status and increased hospital stay or the incidence of PICU admission. By univariate analysis, length of hospital stay and incidence of PICU admission was significantly affected by BSS and by hyponatremia. By multivariate analysis, the only parameter that was significant was BSS. In predicting a longer hospital stay in admitted patients, BSS showed a sensitivity (Se)=77.78%, specificity (Sp)=100%, positive predictive value (PPV)=100%, and negative predictive value (NPV)=42.9 while hyponatremia showed a Se=20.83%, Sp=91.67%, PPV=93.75%, and NPV=16.18. In predicting the need for PICU admission in studied cases, BSS showed a Se=69.23%, Sp=94.92%, PPV=60%, and NPV=96.6 and Se=38.46%, while hyponatremia showed Sp=87.29%, PPV=25%, and NPV=92.79. Conclusion BSS could be used as a valuable tool for assessing the severity of acute bronchiolitis. The presence of hyponatremia on initial presentation, although occasionally observed, cannot be used as a predictor of disease severity, but it could be used as a prognostic factor of a more severe disease course.