Introduction
Recurrent wheezing is very prevalent among infants. Approximately one
third of children experience wheezing at least once by the time they
reach 3 years of age(1). This has a high impact on society due to the
elevated utilization of ED visits and hospitalizations(2).
Among the aspects that most impact the morbidity of patients is the
early identification of patients who may develop or require mechanical
ventilation; the improper delay of mechanical ventilation can increase
the mortality rate(3). As reported in the literature, 5- 43% of
patients failed oxygen support or non-invasive pressure-positive
ventilation and subsequently required mechanical ventilation(4, 5). If
one can predict which patients will require different oxygenation
systems until they reach mechanical ventilation, patients can be put on
mechanical ventilation immediately (3). This prediction would be made
before a patient is put on low system oxygen therapy or non-invasive
pressure-positive ventilation. Models have been developed that predict
the use of oxygen or the use of non-invasive ventilation or mechanical
ventilation, all separately (6). This risk stratification has been
insufficiently studied. In a retrospective cohort study in infants aged
<12 months with bronchiolitis, Freire et al. identified the
following as predictors of received escalated care: oxygen saturation
<90%, nasal flaring and/or grunting, apnea (OR: 3.0[95% CI
1.9–4.8]), retractions, age ≤2 months, dehydration, and poor feeding.
However, this study only included patients in their first wheezing
episode and without any comorbidities; which limits its use since the
majority of patients who receive just escalation are those who have more
than one wheezing episode and have comorbidities(3, 7). The aim of this
study was to determinate the clinical predictors of hospitalization with
airway support (“escalated care”) among infants with recurrent
wheezing evaluated in an emergency department.