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Paediatric Research Across the Midlands

Oxygen saturation thresholds in bronchiolitis - a PRAM multi-centre service evaluation

 

Aims

•The BIDS trial has demonstrated that for patients admitted with bronchiolitis, oxygen saturation (SpO2) threshold of 90% is safe compared to 94%.

•Some centres have now adopted 90% thresholds, and others 92%, we hypothesised that this would affect admissions, and aimed to examine this.

 

 Method

•Prospective multi-centre service evaluation during 4 week period, November 2018.

•Included all admissions for bronchiolitis, exclusions as per BIDS trial.

•Data collection using standardised proforma: reason for admission, SpO2, length of stay.

•Comparison between centres with SpO2 threshold of 90% and those with 92%, using Excel and Graphpad.

 

Results 

•11 centres provided data; 74 exclusions, 295 patients analysed.

•Inadequate feeding was the most common reason for admission (79%).

•Only 19 patients were admitted solely because of low saturations. Median SpO2 in this group was 88% (range 66-90%), only one patient was admitted solely due to Sp02 of 90%, at a 92% threshold centre.

•Median length of stay in centres with 90% threshold was 33 hours, against 59 hours for 92% centres (p= 0.00047)

 

Implications for practice

•Most patients are admitted with bronchiolitis for reasons other than low SpO2, and only one patient with SpO2 of 90% had a potentially avoidable admission, disproving our hypothesis.

•Despite possible confounding factors, this large regional multi-centre project showed length of stay is significantly reduced in 90% threshold centres, suggesting this is where benefits to service may lie from reduction in threshold, this may require further study to confirm.

 

Regional Project Leads:  

Dr Tim van Hasselt, Dr Bhavna Singham, Dr Amy Henderson

 

Local Project Leads:    

• Dr Bhavna Singham

• Dr Andy Taylor

• Dr Vic Parsonson

• Dr Harriet Swallow

• Dr Jo Nuthall

• Dr Sonia Goyal

• Dr Hannah Cooper

• Dr Katy Francis

• Dr Isobel Fullwood

• Dr Liz Fairholme

• Dr Prasadi Desilva

• Dr Deevena Chinthala

• Dr Kun Hu

• Dr Fiona Halton

• Dr Nabil Fassaludhin

 

 

Project Supervisors:    

Dr Ian Wacogne, Dr Eve Bassett

 

Additional Statistics Reviews:

Paul Davies

 

Presentation:                

Midlands Regional Paediatric Society meeting (15th May 2019) won Best Presentation Prize

 

Published in Archives of Disease in Childhood:

https://adc.bmj.com/content/early/2019/08/28/archdischild-2019-317683.full 

PDF link