Usefulness of a clinical scoring system to estimate a degree of seriousness in infants younger than 24 months with respiratory syncytial virus bronchiolitis

Abstract

In order to consider the indication for hospitalization in infants younger than 24 months with respiratory syncytial virus (RSV) bronchiolitis, we established a clinical scoring system, “RSV bronchiolitis clinical score”. This clinical score was composed of respiratory distress assessment score (RDAS) and usual life assessment score (ULAS). The RDAS included oxygen saturation, respiratory rate, wheezing and chest retraction, which were assessed from score 0 to score 2, respectively, then the maximum possible score was 8. The ULAS included sleep and food intake, whichwere also assessed from score 0 to score 2, respectively, then the maximum possible score was 4. We applied this clinical scoring system to the infants with RSV bronchiolitis during the epidemic of 2006-2007 on the day of first visit and made a comparison between the scores of outpatients and those of inpatients. These two groups were not found significant differences in age and the days of first visit, which were around day 4.However, the mean RDAS and ULAS of inpatients were 4.2 and 2.9, respectively, which were significantly higher than those of outpatients, mean RDAS of 2.3 and mean ULAS of 0.9 (p<0.001). We concluded that infants with RSV bronchiolitis with a RDAS of over 4 or a ULAS of over 2 should be defined to be severe and recommended admission.