When to Discharge Children Hospitalized With Pertussis?

Objective

It is difficult to know when children hospitalized with pertussis can be safely discharged. We sought to identify clinical features of children hospitalized with pertussis that are associated with readmission.

Methods

A case series of 207 children hospitalized with pertussis was studied. The 33 children readmitted with pertussis were compared with the 174 who did not require readmission.

Results

Demographic characteristics and immunization status of the children with pertussis requiring readmission did not differ from the children who were not readmitted. Median duration of initial hospital stay was 4 days for both groups (P=.11). The children who were readmitted had more cyanotic episodes per day (0.8 vs 0.0 episodes, P=.03) and on greater proportion of hospital days (0.5 vs 0.1, P=.01). On the last day of admission, the children subsequently readmitted had more coughing episodes (4 vs 0, P < .001), and a larger proportion had a cyanotic episode (30% vs 10%, P=.003). The risk of readmission was increased in children who had ≥1 cyanotic episode per day (relative risk [RR]=2.5, 95% confidence interval [95% CI] 1.3–4.6); cyanosis on ≥50% of days (RR=2.6, 95% CI 1.4–4.8);≥2 coughing paroxysms on the last hospital day (RR=2.4, 95% CI 1.3–4.4); or any cyanosis on the last day (RR=2.9, 95% CI 1.5–5.2).

Conclusions

Paroxysmal cough and cyanosis are clinical signs that can be used in children hospitalized with pertussis to help decide when to discharge them from hospital.

Key Words: hospital discharge, hospitalization, whooping cough