SEPSIS EVALUATIONS IN HOSPITALIZED INFANTS WITH BRONCHIOLITIS

Objectives. To define variation in the decision to perform a sepsis ev aluation in hospitalized infants with bronchiolitis, to define predict ors of the decision and to measure the clinical and cost outcomes. Met hods. Retrospective chart review of all non-intensive care unit infant s less than or equal to 60 days with any discharge diagnosis of bronch iolitis (n = 282 from 1993 to 1995 in a 232-bed pediatric hospital, Pr ocess variables included temperature at sepsis work-up or T-max if no sepsis workup. Outcome variables were charges, length of stay, sepsis workup and serious bacterial infection. Results. There was no differen ce in mean temperature between groups with or without sepsis evaluatio n (38.1 degrees C, P = 0.75). Of 282 infants 140 had a sepsis workup; 5 (1.8%) had serious bacterial infection, Infants with sepsis workup h ad an average total charge of $4507 and length of stay of 3.4 days com pared with $2998 and 2.8 days for those without (P = 0.0001 and P = 0. 002, respectively). A multivariate logistic regression model was const ructed with sepsis workup as the dichotomous dependent variable. Signi ficant (P less than or equal to 0.05) predictor variables with a posit ive coefficient were: higher bronchiolitis score and normal chest roen tgenogram. Significant variables with a negative coefficient were: adm ission diagnosis of bronchiolitis, chest roentgenogram typical for bro nchiolitis and age >28 days. Conclusions. Temperature was not a predic tor of sepsis evaluation. Infants with respiratory distress and normal chest roentgenogram were more likely to receive sepsis evaluations; t hose with recognized typical bronchiolitis and those >28 days of age w ere less likely. Risk of serious bacterial infection is low; the costs of a sepsis evaluation outweigh the benefits in infants with obvious bronchiolitis.