{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T07:52:22Z","timestamp":1772178742371,"version":"3.50.1"},"reference-count":27,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>High-flow nasal cannula (HFNC) use in bronchiolitis has increased substantially with wide variability, likely due to the lack of objective means of predicting clinical outcomes. Our objective was to identify features associated with care escalation for infants started on HFNC in the Emergency Department (ED), thereby assisting in disposition of patients and optimizing the utilization of limited resources.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This is a retrospective cohort study from 3 free-standing children\u2019s hospitals of infants younger than or equal to 12 months with bronchiolitis who were initiated on HFNC in the ED between 2\/1\/2018 and 3\/1\/2020. The primary outcome was escalation of care within the first 24 hours after HFNC initiation [transfer to pediatric intensive care unit (PICU) and\/or initiation of noninvasive positive pressure ventilation (NIPPV) or mechanical ventilation (MV)]. A clinical prediction model was developed using multivariable logistic regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>We included 738 infants with a mean age of 5.4 months (SD 3.4), of which 73 (10%) experienced care escalation within the first 24 hours. Fever, tachypnea, tachycardia, and hypoxemia were associated with escalation, whereas historical features, physical examination findings, and response to ED therapies were not. A prediction model consisting of the highest ED respiratory rate and the lowest oxygen saturation yielded an AUC of 0.75, with a sensitivity of 57.9% and specificity of 82.2% (based on an optimal predicted probability threshold of 7.9%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Hypoxemia and tachypnea predicted early escalation of care in infants with bronchiolitis with moderate performance. This model may have promise to assist with management decisions; however, it requires prospective validation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1097\/pec.0000000000003536","type":"journal-article","created":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T07:00:10Z","timestamp":1768287610000},"page":"218-224","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["High Flow Nasal Cannula Use in Bronchiolitis"],"prefix":"10.1097","volume":"42","author":[{"given":"Lauren K.","family":"Hintz","sequence":"first","affiliation":[{"name":"Division of Pediatric Critical Care Medicine, UH Rainbow Babies & Children\u2019s Hospital, Cleveland, OH"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Doug","family":"Lorenz","sequence":"additional","affiliation":[{"name":"Department of Bioinformatics and Biostatistics, School of Public Health and Information Science, University of Louisville, Louisville, KY"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew J.","family":"Lipshaw","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Cincinnati Children\u2019s Hospital Medical Center, Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, OH"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher","family":"Miller","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Children\u2019s Hospital of Philadelphia, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph J.","family":"Zorc","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Children\u2019s Hospital of Philadelphia, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Irini N.","family":"Kolaitis","sequence":"additional","affiliation":[{"name":"Division of Hospital-Based Medicine, Ann and Robert H. Lurie Children\u2019s Hospital of Chicago & Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeremy M.","family":"Jones","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Children\u2019s Hospital of Philadelphia, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rachel","family":"Rothstein","sequence":"additional","affiliation":[{"name":"Division of General Pediatrics, Children\u2019s Hospital of Philadelphia, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Omar","family":"Shehab","sequence":"additional","affiliation":[{"name":"Division of General Pediatrics, Children\u2019s Hospital of Philadelphia, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Todd A.","family":"Florin","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Ann and Robert H. Lurie Children\u2019s Hospital of Chicago & Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","published-online":{"date-parts":[[2026,1,13]]},"reference":[{"key":"R1-20260227","doi-asserted-by":"crossref","first-page":"e20192614","DOI":"10.1542\/peds.2019-2614","article-title":"Trends in Bronchiolitis Hospitalizations in the United States: 2000-2016","volume":"144","author":"Fujiogi","year":"2019","journal-title":"Pediatrics"},{"key":"R2-20260227","doi-asserted-by":"crossref","first-page":"e0152208","DOI":"10.1371\/journal.pone.0152208","article-title":"Trends in respiratory syncytial virus and bronchiolitis hospitalization rates in high-risk infants in a United States Nationally Representative Database, 1997-2012","volume":"11","author":"Doucette","year":"2016","journal-title":"PLoS One"},{"key":"R3-20260227","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1007\/s00134-012-2743-5","article-title":"Use of high flow nasal cannula in critically ill infants, children, and adults: a critical review of the literature","volume":"39","author":"Lee","year":"2013","journal-title":"Intensive Care Med"},{"key":"R4-20260227","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1186\/s13054-017-1640-2","article-title":"High-flow nasal cannula support therapy: new insights and improving performance","volume":"21","author":"Hern\u00e1ndez","year":"2017","journal-title":"Crit Care"},{"key":"R5-20260227","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1542\/hpeds.2020-002774","article-title":"High-flow nasal cannula in bronchiolitis at a pediatric emergency department: trends and outcomes","volume":"11","author":"Lipshaw","year":"2021","journal-title":"Hosp Pediatr"},{"key":"R6-20260227","doi-asserted-by":"crossref","first-page":"e343","DOI":"10.1097\/PCC.0b013e31825b546f","article-title":"Predictors of failure in infants with viral bronchiolitis treated with high-flow, high-humidity nasal cannula therapy*","volume":"13","author":"Abboud","year":"2012","journal-title":"Pediatr Crit Care Med"},{"key":"R7-20260227","first-page":"CD009609","article-title":"High-flow nasal cannula therapy for infants with bronchiolitis","volume":"2014","author":"Beggs","year":"2014","journal-title":"Cochrane Database Syst Rev"},{"key":"R8-20260227","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1136\/archdischild-2018-315846","article-title":"High-flow nasal cannula therapy for children with bronchiolitis: a systematic review and meta-analysis","volume":"104","author":"Lin","year":"2019","journal-title":"Arch Dis Child"},{"key":"R9-20260227","doi-asserted-by":"crossref","first-page":"847","DOI":"10.1007\/s00134-011-2177-5","article-title":"Reduced intubation rates for infants after introduction of high-flow nasal prong oxygen delivery","volume":"37","author":"Schibler","year":"2011","journal-title":"Intensive Care Med"},{"key":"R10-20260227","doi-asserted-by":"crossref","first-page":"e20194083","DOI":"10.1542\/peds.2019-4083","article-title":"High-flow nasal cannula use outside of the ICU setting","volume":"146","author":"Kalburgi","year":"2020","journal-title":"Pediatrics"},{"key":"R11-20260227","doi-asserted-by":"crossref","first-page":"e242722","DOI":"10.1001\/jamanetworkopen.2024.2722","article-title":"Transition to weight-based high-flow nasal cannula use outside of the ICU for bronchiolitis","volume":"7","author":"Willer","year":"2024","journal-title":"JAMA Netw Open"},{"key":"R12-20260227","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1097\/PEC.0b013e3182440b9b","article-title":"Bronchiolitis: clinical characteristics associated with hospitalization and length of stay","volume":"28","author":"Corneli","year":"2012","journal-title":"Pediatr Emerg Care"},{"key":"R13-20260227","doi-asserted-by":"crossref","first-page":"648","DOI":"10.1136\/adc.2010.201079","article-title":"Clinical predictors of admission in infants with acute bronchiolitis","volume":"96","author":"Marlais","year":"2011","journal-title":"Arch Dis Child"},{"key":"R14-20260227","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1097\/00063110-200410000-00005","article-title":"A validated clinical model to predict the need for admission and length of stay in children with acute bronchiolitis","volume":"11","author":"Walsh","year":"2004","journal-title":"Eur J Emerg Med"},{"key":"R15-20260227","doi-asserted-by":"crossref","first-page":"1132","DOI":"10.1097\/PEC.0b013e31827132ff","article-title":"Risk factors for admission in children with bronchiolitis from pediatric emergency department observation unit","volume":"28","author":"Yusuf","year":"2012","journal-title":"Pediatr Emerg Care"},{"key":"R16-20260227","doi-asserted-by":"crossref","first-page":"887","DOI":"10.1111\/j.1553-2712.2008.00245.x","article-title":"Prospective multicenter bronchiolitis study: predicting intensive care unit admissions","volume":"15","author":"Damore","year":"2008","journal-title":"Acad Emerg Med"},{"key":"R17-20260227","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/j.acap.2014.06.008","article-title":"Risk factors for requiring intensive care among children admitted to ward with bronchiolitis","volume":"15","author":"Hasegawa","year":"2015","journal-title":"Acad Pediatr"},{"key":"R18-20260227","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1016\/j.jpeds.2022.12.006","article-title":"Predictors of intensive care admission in hypoxemic bronchiolitis infants, secondary analysis of a randomized trial","volume":"256","author":"Franklin","year":"2023","journal-title":"J Pediatr"},{"key":"R19-20260227","doi-asserted-by":"crossref","first-page":"e492","DOI":"10.1542\/peds.2012-0444","article-title":"Prospective multicenter study of children with bronchiolitis requiring mechanical ventilation","volume":"130","author":"Mansbach","year":"2012","journal-title":"Pediatrics"},{"issue":"3 Pt 1","key":"R20-20260227","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1542\/peds.104.3.463","article-title":"Predicting deterioration in previously healthy infants hospitalized with respiratory syncytial virus infection","volume":"104","author":"Brooks","year":"1999","journal-title":"Pediatrics"},{"key":"R21-20260227","doi-asserted-by":"crossref","first-page":"530","DOI":"10.1542\/hpeds.2017-0034","article-title":"Risk factors for respiratory decompensation among healthy infants with bronchiolitis","volume":"7","author":"Dadlez","year":"2017","journal-title":"Hosp Pediatr"},{"key":"R22-20260227","doi-asserted-by":"crossref","first-page":"e20174253","DOI":"10.1542\/peds.2017-4253","article-title":"Predicting escalated care in infants with bronchiolitis","volume":"142","author":"Freire","year":"2018","journal-title":"Pediatrics"},{"key":"R23-20260227","doi-asserted-by":"crossref","first-page":"1453","DOI":"10.1016\/S0140-6736(07)61602-X","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"370","author":"von Elm","year":"2007","journal-title":"Lancet"},{"key":"R24-20260227","doi-asserted-by":"crossref","first-page":"g7594","DOI":"10.1136\/bmj.g7594","article-title":"Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD): the TRIPOD statement","volume":"350","author":"Collins","year":"2015","journal-title":"BMJ"},{"key":"R25-20260227","doi-asserted-by":"crossref","first-page":"1049","DOI":"10.1080\/10629360600810434","article-title":"Fully conditional specification in multivariate imputation","volume":"76","author":"Van Buuren","year":"2006","journal-title":"J Stat Comput Simul"},{"key":"R27-20260227","first-page":"1","article-title":"mice: Multivariate Imputation by Chained Equations in R","volume":"45","author":"Van Buuren","year":"2011","journal-title":"Journal of Statistical Software"},{"key":"R29-20260227","doi-asserted-by":"crossref","first-page":"3977","DOI":"10.1007\/s00431-022-04607-4","article-title":"Association between respiratory rate oxygenation index and need for positive pressure ventilation in children on high flow nasal cannula for bronchiolitis","volume":"181","author":"Kannikeswaran","year":"2022","journal-title":"Eur J Pediatr"}],"container-title":["Pediatric Emergency Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/10.1097\/PEC.0000000000003536","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T06:00:21Z","timestamp":1772172021000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.1097\/PEC.0000000000003536"}},"subtitle":["Predicting Need for Early Escalation of Care"],"short-title":[],"issued":{"date-parts":[[2026,1,13]]},"references-count":27,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.1097\/pec.0000000000003536","relation":{},"ISSN":["0749-5161","1535-1815"],"issn-type":[{"value":"0749-5161","type":"print"},{"value":"1535-1815","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,13]]},"assertion":[{"value":"2025-05-28","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-11-21","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}