Medication use in infants admitted with bronchiolitis

Oakley, Ed; Brys, Trusha; Borland, Meredith L; Neutze, Jocelyn; Phillips, Natalie; Krieser, David; Dalziel, Stuart R; Davidson, Andrew; Donath, Susan; Jachno, Kim; South, Mike; Williams, Amanda; Babl, Franz E

doi:10.1111/1742-6723.12968

Cited by 31 publications

(46 citation statements)

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“…Our rates of salbutamol use are lower than previous reports in the Australasian context but remain higher than expected given the strong recommendation. Although evidence in subgroups remains weak, the number needed to treat and lack of evidence for reduction in needing oxygen use or improvement in hospital length of stay has led to the strong recommendation not to use CXR in any subgroup.…”

Section: Discussioncontrasting

confidence: 83%

“…12 An Australasian study showed rates of bronchodilator use in patients admitted to hospital with bronchiolitis varying from 27 to 48.7%, increasing with age. 13 Our institution is a major specialist paediatric hospital with over 85 000 emergency presentations per year and 50 000 inpatient episodes. We produce widely accessed, evidence-based clinical practice guidelines.…”

Section: What This Paper Addsmentioning

confidence: 99%

“…In contrast, the use of bronchodilators is associated with significant adverse effects, such as tachycardia, oxygen desaturation and tremors . An Australasian study showed rates of bronchodilator use in patients admitted to hospital with bronchiolitis varying from 27 to 48.7%, increasing with age …”

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confidence: 99%

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Bronchiolitis at a specialist paediatric centre: The electronic medical record helps to evaluate low‐value care

Lawrence

Andrew

Bracken

et al. 2019

J Paediatrics Child Health

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Aim Low‐value care (LVC) is common. We aimed, using infants presenting to a major tertiary paediatric hospital with bronchiolitis between April 2016 and July 2018, to: (i) assess rates of chest X‐ray (CXR) and medication use; (ii) identify associated factors; and (iii) measure the harm of not performing these practices. Methods We extracted data from the electronic medical record for all children aged 1–12 months given a diagnosis of bronchiolitis in the emergency department. Factors potentially associated with LVC practices were extracted, including patient demographics, ordering physician characteristics, order indication, medications prescribed and admission ward. To assess for harm, a radiologist, blinded to CXR indication, reviewed all CXRs ordered over the winter of 2017 for infants with bronchiolitis. Results A CXR was ordered for 439 (11.2%) infants, most commonly to rule out consolidation and collapse (65%). CXRs were more likely to be ordered for admitted infants (40.9% admitted to the general medical ward), and 62% were ordered by emergency department staff. Salbutamol was prescribed for 9.3% (n = 199). Amongst those who had a CXR, 28% were prescribed an antibiotic compared to 2.1% for those who did not. In an audit of 98 CXRs ordered over the winter of 2017, there were no CXR findings that meaningfully affected patient outcomes. Conclusion Using electronic medical record data, we found that CXR and medication use in bronchiolitis were higher than expected given our hospital guideline advice. Future research needs to understand why and develop interventions to reduce LVC.

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Section: Discussioncontrasting

confidence: 83%

Section: What This Paper Addsmentioning

confidence: 99%

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Bronchiolitis at a specialist paediatric centre: The electronic medical record helps to evaluate low‐value care

Lawrence

Andrew

Bracken

et al. 2019

J Paediatrics Child Health

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“…In this issue of Emergency Medicine Australasia , Oakley et al . report a retrospective review of a cohort of infants with bronchiolitis, examining the use of medications in the treatment of bronchiolitis.…”

Section: Competing Interestsmentioning

confidence: 99%

“…In this issue of Emergency Medicine Australasia, Oakley et al 1 report a retrospective review of a cohort of infants with bronchiolitis, examining the use of medications in the treatment of bronchiolitis. They demonstrate that despite high-quality evidence confirming medications are of no clinical benefit, almost half of the children with bronchiolitis receive at least one such medication during their treatment.…”

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Bronchiolitis: Translating evidence into practice

George

2018

Emerg Medicine Australasia

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Effectiveness of Targeted Interventions on Treatment of Infants With Bronchiolitis

et al. 2021

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In developed countries, bronchiolitis is the most common reason for infants to be admitted to the hospital, and all international bronchiolitis guidelines recommend supportive care; however, significant variation in practice continues with infants receiving non-evidence-based therapies. Deimplementation research aims to reduce the use of low-value care, and advancing science in this area is critical to delivering evidence-based care.OBJECTIVE To determine the effectiveness of targeted interventions vs passive dissemination of an evidence-based bronchiolitis guideline in improving treatment of infants with bronchiolitis.DESIGN, SETTING, AND PARTICIPANTS This international, multicenter cluster randomized clinical trial included 26 hospitals (clusters) in Australia and New Zealand providing tertiary or secondary pediatric care (13 randomized to intervention, 13 to control) during the 2017 bronchiolitis season. Data were collected on 8003 infants for the 3 bronchiolitis seasons (2014-2016) before the implementation period and 3727 infants for the implementation period (2017 bronchiolitis season, May 1-November 30). Data were analyzed from November 16, 2018, to December 9, 2020.INTERVENTIONS Interventions were developed using theories of behavior change to target key factors that influence bronchiolitis management. These interventions included site-based clinical leads, stakeholder meetings, a train-the-trainer workshop, targeted educational delivery, other educational and promotional materials, and audit and feedback. MAIN OUTCOMES AND MEASURESThe primary outcome was compliance during the first 24 hours of care with no use of chest radiography, albuterol, glucocorticoids, antibiotics, and epinephrine, measured retrospectively from medical records of randomly selected infants with bronchiolitis who presented to the hospital. There were no patient-level exclusions.RESULTS A total of 26 hospitals were randomized without dropouts. Analysis was by intention to treat. Baseline data collected on 8003 infants for 3 bronchiolitis seasons (2014)(2015)(2016) before the implementation period were similar between intervention and control hospitals. Implementation period data were collected on 3727 infants, including 2328 boys (62%) and 1399 girls (38%), with a mean (SD) age of 6.0 (3.2) months. A total of 459 (12%) were Māori (New Zealand), and 295 (8%) were Aboriginal/Torres Strait Islander (Australia). Compliance with recommendations was 85.1% (95% CI, 82.6%-89.7%) in intervention hospitals vs 73.0% (95% CI, 65.3%-78.8%) in control hospitals (adjusted risk difference, 14.1%; 95% CI, 6.5%-21.7%; P < .001).CONCLUSIONS AND RELEVANCE Targeted interventions led to improved treatment of infants with bronchiolitis. This study has important implications for bronchiolitis management and the development of effective interventions to deimplement low-value care.TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry: ACTRN12616001567415.

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Medication use in infants admitted with bronchiolitis

Abstract: Medication was used for infants with bronchiolitis frequently and variably in Australia and New Zealand. Medication use increased with age. Better strategies for translating evidence into practice are needed.

Cited by 31 publications

References 43 publications

Bronchiolitis at a specialist paediatric centre: The electronic medical record helps to evaluate low‐value care

Bronchiolitis at a specialist paediatric centre: The electronic medical record helps to evaluate low‐value care

Bronchiolitis: Translating evidence into practice

Effectiveness of Targeted Interventions on Treatment of Infants With Bronchiolitis

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