Multicenter Study of High-Flow Nasal Cannula Initiation and Duration of Use in Bronchiolitis
Bibliographic record
Abstract
BACKGROUND AND OBJECTIVES: There is a paucity of multicenter data on rates of high flow nasal cannula (HFNC) usage in bronchiolitis in the United States, largely because of the absence of standardized coding, with HFNC often subsumed into the larger category of noninvasive mechanical ventilation. METHODS: We examined HFNC utilization in patients with bronchiolitis from a sample of hospitals participating in a national bronchiolitis quality improvement collaborative. Medical records of patients aged <2 years admitted November 2019 to March 2020 were reviewed and hospital-specific bronchiolitis policies were collected. Exclusion criteria were prematurity <32 weeks, any use of mechanical ventilation, and presence of comorbidities. HFNC utilization (including initiation, initiation location, and treatment duration), and hospital length of stay (LOS) were calculated. HFNC utilization was analyzed by individual hospital HFNC policy characteristics. RESULTS: Sixty-one hospitals contributed data on 8296 patients; HFNC was used in 52% (n = 4286) of admissions, with the most common initiation site being the emergency department (ED) (75%, n = 3226). Hospitals that limited HFNC use to PICUs had reduced odds of initiating HFNC (odds ratio, 0.3; 95% confidence interval [CI], 0.3 to 0.4). Hospitals with an ED protocol to delay HFNC initiation had shorter HFNC treatment duration (-12 hours; 95% CI, -15.6 to -8.8) and shorter LOS (-14.9 hours; 95% CI, -18.2 to -11.6). CONCLUSIONS: HFNC was initiated in >50% of patients admitted with bronchiolitis in this hospital cohort, most commonly in the ED. In general, hospitals with policies to limit HFNC use demonstrated decreased odds of HFNC initiation, shorter HFNC duration, and reduced LOS compared with the study population.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".