Paediatric Research Across the Midlands
Oxygen saturation thresholds in bronchiolitis - a PRAM multi-centre service evaluation
•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.
•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.
•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
Dr Ian Wacogne, Dr Eve Bassett
Additional Statistics Reviews:
Midlands Regional Paediatric Society meeting (15th May 2019) won Best Presentation Prize
Published in Archives of Disease in Childhood: