Diagnosis: Coughing; wheezing
Issue under review: Inpatient admission

Determination:
The Inpatient admission was not medically necessary.

The patient is a male child. He was taken to the ED because of coughing and difficulty breathing.

This young child presented with signs and symptoms of respiratory distress consistent with viral respiratory infection and reactive airway disease. He had received dexamethasone in the outpatient setting as well as amoxicillin for otitis media prior to presentation, but developed worsening symptoms nonetheless. He received prednisolone and albuterol/Atrovent in the ED, and because he remained symptomatic, was admitted for further care. While it was reasonable to manage this child in the hospital with frequent albuterol treatments every two hours, as well as enteral steroids, he was overall hemodynamically stable, with no evidence of sepsis or impending respiratory failure, no significant dehydration, and no oxygen requirement. He did not require acute inpatient management and could have been safely managed at a lower level of care, such as observation.