Walsh et al reported clinical decision rules to evaluate infants in the Emergency Department with bronchiolitis. These can help to identify an infant who should be admitted because of risk for central apnea. The authors are from Sutter Medical Center (Sacramento), University of California at Davis, Kern Medical Center (Bakersfield), University College Dublin and Instituto Nacional de Salud Publica in Mexico.
Patient selection: infant with bronchiolitis in the Emergency Department
Outcome: admission to the hospital for risk of central apnea
The authors developed 3 rules. One was a forrest plot which was not reported.
Clinical rule A - Admit for apnea if any of the following is present:
(1) parent reports central apnea
(2) birthweight was <= 2.5 grams
(3) age <= 6 weeks
Clinical rule B was a CART analysis with decision nodes for admission:
Current Weight in kg
Birth Weight in kg
Parent Reports Apnea
SaO2 in percent
age in weeks
Action
> 5.1
> 3.1
NA
NA
NA
discharge
> 5.1
<= 3.1
NA
<= 90%
NA
admit
> 5.1
<= 3.1
Yes
> 90%
NA
admit
> 5.1
<= 3.1
No
> 90%
NA
discharge
<= 5.1
NA
Yes
NA
NA
admit
<= 5.1
NA
No
NA
<= 6
admit
<= 5.1
<= 2
No
NA
> 6
admit
<= 5.1
> 2
No
NA
> 6
discharge
where:
• In the last 2 rows one option is to change cutoff from 2 to 2.5 to coincide with rule A.
Performance:
• Both rules showed a sensitivity of 100% and a negative predictive value of 100%.
• The specificity was 62% for rule A and 71% for rule B.
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