PEDIATRICS Vol. 104 No. 3 September 1999, pp. 463-467
Predicting Deterioration in Previously Healthy Infants Hospitalized With Respiratory Syncytial Virus Infection
Received Oct 27, 1998; accepted Mar 24, 1999.
From the Department of Pediatrics, Children's Hospital at Strong, University of Rochester School of Medicine and Dentistry, Rochester, New York.
Objective. To estimate the incidence of clinical deterioration leading to intensive care unit transfer in previously healthy infants with respiratory syncytial virus (RSV) infection hospitalized on a general pediatric unit and, to assess the hypothesis that history, physical examination, oximetry, and chest radiographic findings at time of presentation can accurately identify these infants.
Study Design. A virology database was used to identify and
determine the disposition of all children 
1 year of age admitted to
the Children's Hospital at Strong (CHaS) with RSV infection during the
1985 to 1994 respiratory seasons. Index patients were all
previously healthy, full-term infants admitted initially to the general
inpatient services at CHaS or Rochester General Hospital, a
second University of Rochester teaching hospital, whose clinical
deterioration led to transfer to the pediatric intensive care unit
(PICU). These infants were matched retrospectively (for year and date
of infection, sex, chronologic age, and race) with two hospitalized
controls who did not require PICU transfer. Chest radiographic
findings, respiratory rate (RR), O2 saturation, and
presence of wheezing at time of presentation to the emergency
department (ED) were compared.
Results. During the study years, 542 previously healthy,
full-term infants were admitted to the general pediatric unit at CHaS
with proven RSV infection. Ten (1.8%; 95% confidence interval, 0.9%, 3.4%) were transferred subsequently to the PICU, primarily for close
monitoring of progressive respiratory distress. Data for these patients
and 7 patients transferred from Rochester General Hospital to the PICU
at the CHaS were compared with those for control patients. The mean RR
in the ED (63 vs 50), and O2 saturation in the ED (88% vs
93%) were modestly abnormal in cases compared with controls. Wheezing
on examination at time of presentation and chest radiographic findings
did not differ between the two groups. A RR >80 and an O2
saturation <85% at time of presentation each had a specificity >97%
for predicting subsequent deterioration. Each parameter, however, had a
sensitivity 30%.
Conclusion. Clinical deterioration requiring PICU admission is an uncommon occurrence in previously healthy infants admitted to a general pediatric inpatient unit with RSV infection. Extreme tachypnea and hypoxemia were both associated with subsequent deterioration; however, only a small proportion of patients who clinically deteriorated presented in this way. The clinical usefulness of these parameters, therefore, is limited.respiratory syncytial virus, deterioration, healthy infants, prediction. .
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