P2.155: High-Flow Nasal Cannula Initiation Based on Bronchiolitis Severity Score for Children in the Emergency Department

Background: Bronchiolitis remains the leading cause of emergency department (ED) visits and hospitalizations in children under two years of age. Early identification of disease severity is critical to guiding treatment decisions, including oxygen therapy and high-flow nasal cannula (HFNC) initiation. While validated bronchiolitis severity scores, such as the Bronchiolitis Severity Score (BSS), aid in stratifying patient risk, there is limited evidence linking these scores to clinical outcomes. This study investigates the association between BSS and HFNC initiation, aiming to enhance risk stratification and clinical decision-making in pediatric bronchiolitis management in the ED.

Methods: We conducted a retrospective cohort study of children aged 1–24 months diagnosed with bronchiolitis across multiple EDs in a pediatric healthcare system. BSS was calculated from clinical respiratory data to evaluate its predictive utility. The primary outcome was the likelihood of HFNC initiation based on BSS categories, with a secondary analysis of individual BSS components. Secondary outcomes included time to HFNC initiation, ED disposition, and length of stay. Chi-square and binary logistic regression analyses were performed, adjusting for patient demographics and potential confounders.

Results: A total of 199 patients were included, with a median age of 11 months (IQR 4–15 months). Compared to patients with mild BSS, those with moderate scores had a higher likelihood of HFNC initiation (OR 3.0, 95% CI 1.5–6.1, p=0.002). Patients with severe scores had the greatest likelihood (OR 4.3, 95% CI 0.9–20.2, p=0.063), reaching statistical significance after adjusting for confounders (OR 7.4, 95% CI 1.4–38.9, p=0.019). Among the BSS components, accessory muscle use and dyspnea were significantly associated with HFNC initiation, whereas respiratory rate showed mixed results, and wheezing lacked significance.

Conclusion: The Bronchiolitis Severity Score effectively correlates with illness severity and HFNC use, demonstrating its potential as a clinical tool to optimize bronchiolitis management. Integrating respiratory scoring into ED workflows may facilitate early risk assessment, streamline resource allocation, and improve patient outcomes in the ED. Future studies with larger datasets should further explore the predictive value of the longitudinal use of BSS across diverse healthcare settings, including primary care and inpatient units.