Management of acute bronchiolitis in emergency wards in Spain: variability and appropriateness analysis (aBREVIADo Project)

Abstract

There are discrepancies between clinical practice and evidence-based management of bronchiolitis in Spanish emergency departments. Inappropriate treatments were used in more than half of patients. The wide variation between centers shows the influence of local prescribing habits and reveals the scope for improvement.

Practice Variations between Emergency Physicians and Pediatricians in Treating Acute Bronchiolitis in the Emergency Department: A Nationwide Study

“…Overuse of ineffective diagnostic testing may reflect uncertainty regarding the presenting diagnosis, and a trend in ''defensive medicine'' (i.e., to avoid misdiagnosis), which is common in ED (20)(21)(22). In the current study, about 20%-30% of patients underwent laboratory testing in the ED, which is quite different, for example, from the 0%-25.7% rate found in Spanish EDs (16). Although CBCs and blood cultures are frequently used to detect bacterial infection, they do not seem to be necessary in acute bronchiolitis (23).…”

“…In addition, only 14.9% of patients with acute bronchiolitis underwent chest x-ray study in Spain (16). In Taiwan, the current results demonstrate that 63.7% and 46% patients underwent chest x-ray study when managed by EPs and pediatricians, respectively.…”

“…Acute bronchiolitis is a self-limiting viral respiratory tract infection in infancy, and supportive care is the mainstay treatment (12). Many studies have demonstrated variation in diagnostic testing, treatment, hospital admission rates, and length of stay for bronchiolitis before the release of the 2006 AAP bronchiolitis recommendations; however, use of nonÀevidence-based testing and therapies remains common (13)(14)(15)(16). The discrepancy between guideline and reallife clinical practice deserves further studies to verify.…”

Utilisation and Off-Label Prescriptions of Respiratory Drugs in Children

“…Of course in some patients, bronchodilators may lead to a transient clinical improvement but this should be weighed against potential adverse effects and the fact that most children will not benefit [20]. Nevertheless, as shown by de Brasi et al [19] and Ochoa Sangrador et al [24], there is a relevant overuse of both compounds which has been attributed to e.g. physicians' recognition of disease severity, personal reassurance, and parental pressure [19].…”

Improving Physicians' Adherence to Guidelines Regarding Antibiotics Use in Acute Upper Respiratory Tract Infections in Adult Patients Attending Ministry of Health Hospitals in Alexandria, Egypt: An Interventional Study

“…Poor management was still seen in misclassification and differentiation between disease types leading to inappropriate treatment [7]. In Spain 2012, it was found that there is a high rate of discrepancies between clinical practice and evidence-based management of RTIs seen in more than half of the patients visiting RTIs outpatient clinics referring for the importance of the use of clinical guidelines [8]. The establishing of guidelines aims to increase physicians' adherence and assists them to make decisions on treating specified conditions of URTI as sinusitis, pharyngitis, bronchitis in adult outpatients [9].…”