Bronchiolitis Management Before and After the AAP Guidelines

Parikh, Kavita; Hall, Matthew; Teach, Stephen J.

doi:10.1542/peds.2013-2005

Cited by 152 publications

(157 citation statements)

References 18 publications

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“…43 Specifically, the average rate of steroid use was 16%, whereas our proposed achievable benchmark was 1%; average rate of antibiotic use was 33%, and our proposed benchmark was 17%; and…”

Section: Discussionmentioning

confidence: 86%

Effectiveness of Quality Improvement in Hospitalization for Bronchiolitis: A Systematic Review

et al. 2014

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BACKGROUND: Bronchiolitis causes nearly 20% of all acute care hospitalizations for young children in the United States. Unnecessary testing and medication for infants with bronchiolitis contribute to cost without improving outcomes. OBJECTIVES:The goal of this study was to systematically review the quality improvement (QI) literature on inpatient bronchiolitis and to propose benchmarks for reducing unnecessary care. METHODS:Assisted by a medical librarian, we searched Medline, Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Library. Studies describing any active QI intervention versus usual care in hospitalized children ,2 years of age were included. Data were extracted and confirmed by multiple investigators and pooled by using a random effects model. Benchmarks were calculated by using achievable benchmarks of care methods. RESULTS:Fourteen studies involving .12 000 infants were reviewed. QI interventions resulted in 16 fewer patients exposed to repeated doses of bronchodilators per 100 hospitalized (7 studies) (risk difference: 0.16 [95% confidence interval: 0.11-0.21]) and resulted in 5.3 fewer doses of bronchodilator given per patient (95% confidence interval: 2

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“…43 Specifically, the average rate of steroid use was 16%, whereas our proposed achievable benchmark was 1%; average rate of antibiotic use was 33%, and our proposed benchmark was 17%; and…”

Section: Discussionmentioning

confidence: 86%

Effectiveness of Quality Improvement in Hospitalization for Bronchiolitis: A Systematic Review

et al. 2014

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“…36 Interestingly, when change in bronchiolitis inpatient management was examined across many of these same pediatric hospitals before and after publication of the AAP bronchiolitis CPG, a significant improvement was seen in the use of chest x-rays, systemic corticosteroids, and bronchodilators over time. 37 Clearly, as with many medical conditions, changing bronchiolitis care is a complex endeavour. There is evidence that exposure to increased volumes of patients with bronchiolitis is associated with decreased use of investigations and medications.…”

Section: Discussionmentioning

confidence: 99%

Management of Bronchiolitis in Community Hospitals in Ontario: a Multicentre Cohort Study

Plint

Taljaard

McGahern³

et al. 2016

CJEM

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Objectives: Bronchiolitis is the leading cause of hospital admission for infants, but few studies have examined management of this condition in community hospital settings. We reviewed the management of children with bronchiolitis presenting to community hospitals in Ontario. Methods: We retrospectively reviewed a consecutive cohort of infants less than 12 months old with bronchiolitis who presented to 28 Ontario community hospitals over a two-year period. Bronchiolitis was defined as first episode of wheezing associated with signs of an upper respiratory tract infection during respiratory syncytial virus season. Results: Of 543 eligible children, 161 (29.7%, 95% Confidence Interval (CI) 22.3 to 37.0%) were admitted to hospital. Hospital admission rates varied widely (Interquartile Range 0%-40.3%). Bronchodilator use was widespread in the emergency department (ED) (79.7% of patients, 95% CI 75.0 to 84.5%) and on the inpatient wards (94.4% of patients, 95% CI 90.2 to 98.6%). Salbutamol was the most commonly used bronchodilator. At ED discharge 44.7% (95% CI 37.5 to 51.9%) of patients were prescribed a bronchodilator medication. Approximately one-third of ED patients (30.8%, 95% CI 22.7 to 38.8%), 50.3% (95% CI 37.7 to 63.0%) of inpatients, and 23.5% (95% CI 14.4 to 32.7) of patients discharged from the ED were treated with corticosteroids. The most common investigation obtained was a chest x-ray (60.2% of all children; 95% CI 51.9 to 68.5%). Conclusions: Infants with bronchiolitis receive medications and investigations for which there is little evidence of benefit. This suggests a need for knowledge translation strategies directed to community hospitals. RÉSUMÉObjectif: La bronchiolite est le principal motif d'hospitalisation des enfants en bas âge, mais peu d'études ont porté sur la prise en charge de la maladie, dans les hôpitaux communautaires. Les auteurs de l'étude ont donc examiné la prise en charge de la maladie chez les enfants traités dans les hôpitaux communautaires, en Ontario. Méthode: Les auteurs ont procédé à un examen rétrospectif d'une cohorte d'enfants consécutifs, âgés de moins de 12 mois, qui souffraient d'une bronchiolite et qui ont été traités dans 28 hôpitaux communautaires en Ontario, sur une période de 2 ans. La bronchiolite a été définie comme un premier épisode de respiration sifflante, associé à des signes d'une infection des voies respiratoires supérieures durant la période du virus respiratoire syncytial. Résultats: Sur 543 enfants admissibles à l'étude, 161 (29,7%; intervalle de confiance [IC] à 95% : 22,3 à 37,0%) ont été hospitalisés. Les taux d'admission à l'hôpital variaient énormément (intervalle interquartile : 0-40,3%). L'utilisation des bronchodilatateurs était courante au service des urgences (SU) (79,7% des patients; IC à 95% : 75,0 à 84,5%) ainsi qu'à l'étage (94,4% des patients; IC à 95% : 90,2 à 98,6%). Le salbutamol était le brochodilatateur le plus utilisé. Au moment du congé du SU, un brochodilatateur avait été prescrit à 44,7% (IC à 95% : 37,5 à 51,9%) des pa...

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“…31 This study compared a preguideline season (2004)(2005) One major limitation of our study is an absence of data integrity controls. Cohort participants performed their own chart review and entered their own data, which would allow for social desirability bias to affect our results; for example, the desire to appear improved may have unconsciously motivated individuals to alter results.…”

Section: Figurementioning

confidence: 99%

A Multicenter Collaborative to Reduce Unnecessary Care in Inpatient Bronchiolitis

et al. 2016

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Dr Ralston conceptualized the project and codirected its implementation, coordinated and critically reviewed all analyses, and drafted the initial manuscript; Dr Garber conceptualized the project and codirected its implementation and critically reviewed and revised the manuscript; Ms Rice-Conboy coordinated all aspects of project design, implementation, and data collection and critically reviewed and revised the manuscript; Drs Mussman, Shadman, and Walley provided project leadership and content, performed a portion of the analysis, and critically reviewed and revised the manuscript; Ms Nichols performed the analyses, prepared all tables and fi gures, and critically reviewed the manuscript; and all authors approved the fi nal manuscript as submitted.

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Bronchiolitis Management Before and After the AAP Guidelines

Cited by 152 publications

References 18 publications

Effectiveness of Quality Improvement in Hospitalization for Bronchiolitis: A Systematic Review

Effectiveness of Quality Improvement in Hospitalization for Bronchiolitis: A Systematic Review

Management of Bronchiolitis in Community Hospitals in Ontario: a Multicentre Cohort Study

A Multicenter Collaborative to Reduce Unnecessary Care in Inpatient Bronchiolitis

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