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.