(865) Outcomes of PICU Bronchiolitis in the Trichotomous Outcome Prediction in Critical Care Study Dataset

Introduction: As mortality in pediatric intensive care units (PICU) has decreased, focus has shifted towards decreasing morbidity. The functional status score (FSS) was developed to better measure morbidity in PICU patients. We have shown that ~10% of PICU patients with bronchiolitis, a viral lower respiratory tract infection of children < 2yo, have measurable morbidity using other tools, but its outcomes using FSS are unavailable.

Methods: With IRB approval, we extracted data from the Trichotomous Outcome Prediction in Critical Care (TOPICC) database hosted by the NICHD DASH for patients with inclusion criteria: < 2yo at admission, primary diagnosis of “respiratory distress/failure” and secondary diagnosis of “pneumonia/bronchiolitis”. Chi squared was used to identify categorical variables associated with morbidity, defined as an FSS that worsened (increased) from baseline to hospital discharge. Mortality was defined at hospital discharge, and non-survivors were excluded from analysis.  A p-value < 0.05 defined statistical significance.

Results: Of 10,078 children in the TOPICC study cared for at 7 centers in 2011-2013, 527 met all inclusion criteria. Their median age was 0.5 (IQR: 0.2-1.0) years, 57% were male, 58% white, 68% publicly insured, 56% had no reported comorbidities and 7 (1.3%) died. Median baseline FSS was 6 (6-7) and discharge was 6 (6-8). Morbidity was observed in 70 (13%), with 24% of those worsening by ≥3 points. Morbidity was not associated with age, race or rate of public insurance. Morbidity was associated with invasive mechanical ventilation (56% vs 35%, p < 0.001), vasoactive infusions (29% vs 9%, p < 0.001), neuromuscular blockade (46% vs 17%, p < 0.001), and parenteral nutrition (23% vs 5%, p < 0.001). Comorbidity categories associated with morbidity included gastrointestinal (19% vs 9%, p = 0.01) and congenital cardiac disease (30% vs 11%, p < 0.001), but not neurological or non-congenital cardiac disease.

Conclusions: Nearly one in six children with critical bronchiolitis have a FSS that worsened during hospitalization, especially those receiving mechanical ventilation and with certain comorbidities. Further investigation is needed to determine modifiable risk factors and treatment approaches that lessen the risk of acquired morbidity.