Direct Medical Costs of Bronchiolitis Hospitalizations in the United States

Pelletier, Andrea J.; Mansbach, Jonathan M.; Camargo, Carlos A.

doi:10.1542/peds.2006-1193

Cited by 250 publications

(220 citation statements)

References 34 publications

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“…[21][22][23][24][25] Our finding of high reported variability in the routine care of all of these conditions except asthma is concerning, as it suggests that experts do not agree on how to manage children hospitalized with even the most common childhood diseases. While we hypothesized that there would be some variation in the use of therapies whose benefit has not been well established, the high degree of variation observed is of concern because it indicates that an insufficient evidentiary base exists to support much of our day-to-day practice.…”

Section: Discussionmentioning

confidence: 99%

Variation in pediatric hospitalists' use of proven and unproven therapies: A study from the Pediatric Research in Inpatient Settings (PRIS) network

Landrigan

Conway

Stucky

et al. 2008

Journal of Hospital Medicine

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BACKGROUND:Undesirable practice variation remains a major concern with the quality of the healthcare system. While care in pediatric hospitalist systems has been demonstrated to be efficient, neither the quality of care nor determinants of variation in pediatric hospitalist systems are well understood.OBJECTIVE:To measure variation in pediatric hospitalists' reported use of common inpatient therapies, and to test the hypothesis that variation in reported use of proven therapies is lower than variation in reported use of unproven therapies.DESIGN AND MEASUREMENTS:We conducted a survey of pediatric hospitalists in the US and Canada. Respondents reported their frequency of using 14 therapies in the management of common conditions. Each therapy was determined to be of proven or unproven effectiveness using published critical appraisals. Variation in reported use of proven and unproven therapies was compared.RESULTS:67% (213/320) of surveyed individuals participated. Little variability existed in reported use of albuterol and corticosteroids in asthma (4‐6% of respondents reported not often using them) and systemic dexamethasone in bronchiolitis (12% of respondents reported using it more than rarely). Moderate to high variation existed in reported use of all other therapies studied. Variation in reported use of proven therapies was significantly less than variation in reported use of unproven therapies (15.5 ± 12.5% vs. 44.6 ± 20.5%).CONCLUSIONS:Substantial variation exists in hospitalists' reported management of common pediatric conditions. Variation is significantly lower for strongly evidence‐based therapies. To decrease undesirable variation in care, a stronger evidence base for inpatient pediatric care must be built. Journal of Hospital Medicine 2008;3:292–298. © 2008 Society of Hospital Medicine.

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Section: Discussionmentioning

confidence: 99%

Variation in pediatric hospitalists' use of proven and unproven therapies: A study from the Pediatric Research in Inpatient Settings (PRIS) network

Landrigan

Conway

Stucky

et al. 2008

Journal of Hospital Medicine

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“…[1][2][3] Total inpatient charges exceed $1.7 billion annually and mean length of stay (LOS) is 2.4 days. 3 Treatment of this common and costly condition is mainly supportive, as previous studies suggest little benefit from bronchodilators, 4,5 antibiotics, 6 or steroids.…”

Section: What This Study Addsmentioning

confidence: 99%

3% Hypertonic Saline Versus Normal Saline in Inpatient Bronchiolitis: A Randomized Controlled Trial

Silver¹,

Esteban-Cruciani²,

Azzarone³

et al. 2015

Pediatrics

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a abstract BACKGROUND AND OBJECTIVES: Bronchiolitis, the most common reason for hospitalization in children younger than 1 year in the United States, has no proven therapies effective beyond supportive care. We aimed to investigate the effect of nebulized 3% hypertonic saline (HS) compared with nebulized normal saline (NS) on length of stay (LOS) in infants hospitalized with bronchiolitis. METHODS:We conducted a prospective, randomized, double-blind, controlled trial in an urban tertiary care children's hospital in 227 infants younger than 12 months old admitted with a diagnosis of bronchiolitis (190 completed the study); 113 infants were randomized to HS (93 completed the study), and 114 to NS (97 completed the study). Subjects received 4 mL nebulized 3% HS or 4 mL 0.9% NS every 4 hours from enrollment until hospital discharge. The primary outcome was median LOS. Secondary outcomes were total adverse events, subdivided as clinical worsening and readmissions.RESULTS: Patient characteristics were similar in groups. In intention-to-treat analysis, median LOS (interquartile range) of HS and NS groups was 2.1 (1.2-4.6) vs 2.1 days (1.2-3.8), respectively, P = .73. We confirmed findings with per-protocol analysis, HS and NS groups with 2.0 (1.3-3.3) and 2.0 days (1.2-3.0), respectively, P = .96. Seven-day readmission rate for HS and NS groups were 4.3% and 3.1%, respectively, P = .77. Clinical worsening events were similar between groups (9% vs 8%, P = .97).CONCLUSIONS: Among infants admitted to the hospital with bronchiolitis, treatment with nebulized 3% HS compared with NS had no difference in LOS or 7-day readmission rates.WHAT'S KNOWN ON THIS SUBJECT: Bronchiolitis, the most frequent reason for hospitalization for infants younger than 1 year of age, has no proven treatments beyond supportive care. Although early studies suggested a potential benefit from 3% hypertonic saline, more recent studies have conflicting results. WHAT THIS STUDY ADDS:This prospective, randomized, double-blind, controlled trial in infants admitted with bronchiolitis (including patients with a history of previous wheeze) demonstrated no difference in length of stay between those who received hypertonic saline or normal saline without bronchodilators.

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“…However, considering that virtually all children before the age of 2 years could be infected, the cost of the disease determined by hospital admissions is elevated. In the United States it has been shown that the burden of the disease is considerable, having an annual cost of more than $500 million (2) and being responsible for 17% of all infant hospitalizations (2). Even though immune prophylaxis with monoclonal antibodies (Palivizumab") has shown promising results in terms of reduction of the prevalence of the disease, this strategy cannot be applied to the whole population because of the high costs.…”

mentioning

confidence: 99%

Effectiveness of Nebulized Hypertonic Saline and Epinephrine in Hospitalized Infants with Bronchiolitis

Giudice

Saitta²,

Leonardi

et al. 2012

Int J Immunopathol Pharmacol

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The objective of the study is to verify effects of nebulized 3% saline hypertonic solution (HS) in comparison to normal saline (NS) in addition to epinephrine in hospitalized children with bronchiolitis. Infants were randomly assigned either to receive every 6 hours nebulized NS (group I) or 3% HS (group II) in addition to epinephrine (1.5 mg) and to conventional treatment. The main endpoints of this study were the length of stay (LOS) in hospital and the clinical response score (CSS). Patients presented a significant decrease in CSS from the first through the third day of treatment, present in the first group but even more evident in the second group (p=0.0001). Comparison between group I and II data shows significant decrease in CSS in the 3% HS-treated patients both at the second (p<0.005) and at the third day of treatment (p<0.005). Infants in the NS control group had a mean LOS of 5.6±1.6 days, whereas children treated with 3% HS were discharged with a LOS of 4.9±1.3 days, reaching a significant decrease in stay (p<0.05). In hospitalized patients bronchiolitis nebulized 3% HS and epinephrine significantly decreased symptoms and LOS as compared to 0.9% NS and epinephrine.

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Direct Medical Costs of Bronchiolitis Hospitalizations in the United States

Cited by 250 publications

References 34 publications

Variation in pediatric hospitalists' use of proven and unproven therapies: A study from the Pediatric Research in Inpatient Settings (PRIS) network

Variation in pediatric hospitalists' use of proven and unproven therapies: A study from the Pediatric Research in Inpatient Settings (PRIS) network

3% Hypertonic Saline Versus Normal Saline in Inpatient Bronchiolitis: A Randomized Controlled Trial

Effectiveness of Nebulized Hypertonic Saline and Epinephrine in Hospitalized Infants with Bronchiolitis

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