Variability in Inpatient Management of Children Hospitalized With Bronchiolitis

Macias, Charles G.; Mansbach, Jonathan M.; Fisher, Erin; Riederer, Mark; Piedra, Pedro A.; Sullivan, Ashley F.; Espinola, Janice A.; Camargo, Carlos A.

doi:10.1016/j.acap.2014.07.005

Cited by 58 publications

(50 citation statements)

References 37 publications

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“…Standardizing discharge criteria for bronchiolitis may help reduce the wide variability in length of stay that exists among different countries and even across institutions within the same country. (11, 12, 41, 42) A reduction in duration of hospitalization can bring important benefits not only for patients but also for healthcare facilities, as it decreases the risk of nosocomial infections, the likelihood of medical errors and hospital costs, and allows a more efficient bed turnover. (43) In addition to these objective outcomes, others not so easy to measure but important potential benefits of a timely discharge, include reestablishing the infant’s and family routine, which in turn may help patient recovery.…”

Section: Discussionmentioning

confidence: 99%

“…(4, 8–10) These factors may contribute to the wide variability in length of stay reported among different institutions, both in USA and across the world. (11, 12) Standardizing clinical criteria for bronchiolitis is especially relevant in an era where new interventions for prevention and treatment of RSV infection are being evaluated in clinical studies. (13–16)…”

Section: Introductionmentioning

confidence: 99%

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Discharge Criteria for Bronchiolitis

Garcia-Maurino

Moore‐Clingenpeel

Wallihan

et al. 2018

Pediatric Infectious Disease Journal

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Background: Admission criteria and standardized management strategies for bronchiolitis are addressed in several guidelines and have shown to be beneficial; however, guidance regarding discharge criteria is limited and widely variable. We assessed the impact on clinical outcomes of a discharge protocol for children <2 years of age hospitalized with bronchiolitis in a tertiary care pediatric hospital. Methods: In October 2013, a protocol to standardize the discharge of children with bronchiolitis was implemented in the infectious diseases (ID) ward but not in other pediatric units caring for these children (non-ID). The protocol included objective clinical criteria and a standardized oxygen weaning pathway. Patients were identified via International Classification of Diseases-9 codes and data manually reviewed. We compared length of stay (LOS) and readmission rates within 2 weeks of discharge according to protocol implementation (ID versus non-ID), adjusted for demographic factors, comorbidities, viral etiology and stratified by pediatric intensive care unit admission. Results: From October 2013 to May 2015, 1118 children were hospitalized in ID and 695 in non-ID units. Median age was 4.5 months, 55% were males and 28% had comorbidities. LOS was 36% longer in non-ID units (risk ratio: 1.36 [1.27–1.45]; P < 0.001) adjusted for age, gender, comorbidities and viral etiology. Difference in LOS remained significant after excluding children with comorbidities and stratifying by pediatric intensive care unit admission. Readmission rates were comparable between units (ID, 2.9% versus non-ID, 2.6%). Conclusions: A standardized discharge protocol for bronchiolitis reduced LOS without increasing readmission rates. Unifying bronchiolitis discharge criteria and oxygen weaning pathways could positively impact hospital-based patient care for this condition.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Discharge Criteria for Bronchiolitis

Garcia-Maurino

Moore‐Clingenpeel

Wallihan

et al. 2018

Pediatric Infectious Disease Journal

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“…11 Rates of bronchodilator use have declined from 90%, in 2007-2012 to 25% and rates of chest radiographs have declined from 52-85% to 10 35%. 48 However, there still remain significantly high rates of use of non-recommended therapies and wide variation in the use of therapeutic interven tions among hospitals in the US. 48 The PERN study highlights this same variation on an international scale confirming that location of care, regardless of disease severity, is the main predictor of bronchi olitis management.…”

Section: Nebulized Epinephrinementioning

confidence: 99%

“…48 However, there still remain significantly high rates of use of non-recommended therapies and wide variation in the use of therapeutic interven tions among hospitals in the US. 48 The PERN study highlights this same variation on an international scale confirming that location of care, regardless of disease severity, is the main predictor of bronchi olitis management. 11 The current guidelines and recent findings highlight the importance of standardizing acute care of bronchiolitis with evidence based point-of-care clin ical practice pathways for ED physicians combined with multidisciplinary institutional pathways.…”

Section: Nebulized Epinephrinementioning

confidence: 99%

Improving Evidence Based Bronchiolitis Care

Cahill

Cohen

2018

Clinical Pediatric Emergency Medicine

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publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active. Abstract:Bronchiolitis is the number one cause of hospitalization in infants during the first year of life. Clinical guidelines recom mend primarily supportive care and discourage use of pharmacotherapies and diagnostics. However, there con tinues to be widespread use of nonrecommended therapies and variation in the use of therapeutic interventions among hospitals in the United States.Here we review evidence-based man agement of this common disease in order to optimize resource utilization, decrease healthcare costs, and de crease unnecessary hospitalization. Current evidence does not support the routine use of chest radiographs, viral testing or laboratory evaluation in chil dren with bronchiolitis. In addition, rou tine administration of bronchodilators, including albuterol and nebulized epi nephrine, corticosteroids and hypertonic saline are not recommended for infants and children with bronchiolitis. Intrave nous or nasogastric hydration and nutri tional support, supplemental oxygen, and respiratory support are recom mended. Standardization of bronchiolitis care with evidence based institutional clinical pathways spanning ED to inpa tient care can help optimize resource utilization while simultaneously improv ing care of bronchiolitis and reducing hospital length of stays and costs.

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“…Pero hay poca evidencia de la eficacia del uso de corticosteroides en el tratamiento de la bronquiolitis y no es recomendada en las guías respectivas (27) . Actualmente, se siguen usando en la práctica clínica tanto los broncodilatadores como corticosteroides por la cercanía que hay entre la bronquiolitis y el asma (28) .…”

Section: Tratamiento Farmacológicounclassified

Bronquiolitis

Estrada

Vesga

Restrepo

2017

Pediatr

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Aceptado el 15 de agosto de 2017 Palabras clave:Bronquiolitis aguda virus sincitial respiratorio epidemiología microbiología solución salina hipertónica. R E S U M E NLa bronquiolitis es una enfermedad que involucra las vías respiratorias inferiores y afecta a un gran número de lactantes en el mundo. Se estima que a causa de esta enfermedad hay, anualmente, 3.4 millones de admisiones hospitalarias y 199,000 muertes en los países en vía de desarrollo. La enfermedad es más frecuente en las temporadas de lluvia y existen múltiples factores de riesgo que pueden aumentar su gravedad.El agente causal más importante de la bronquiolitis es el virus sincitial respiratorio, el cual se transmite por medio de fómites nasales. El cuadro clínico inicia con síntomas de la vía aérea superior que progresan a las vías aéreas inferiores, llegando a causar insuficiencia respiratoria como consecuencia de una alta liberación de mediadores proinflamatorios. El diagnóstico es clínico, sin embargo, se utilizan otros métodos diagnósticos cuando hay sospecha de otra patología. Diferentes terapias han sido propuestas para su manejo clínico, que se basan en medidas de sostén para el paciente, el uso de oxígeno, nebulizaciones de solución salina hipertónica, corticosteroides, antivirales, profilaxis con palivizumab y, más recientemente, el uso de sulfato de zinc.Todavía existe un considerable desconocimiento acerca de algunos aspectos relacionados con el manejo de esta enfermedad. Sin embargo, se han descubierto nuevos mecanismos fisiopatológicos que en un futuro podrían llegar a ser un blanco terapéutico. Bronchiolitis: a Current Perspective A B S T R A C TBronchiolitis is a disease that involves the lower respiratory tract and affects large numbers of nurslings worldwide. It is estimated that as a result of this disease there are, in developing countries, 3.4 million hospital admissions and 199,000 deaths per year. This disease is more frequent in rainy seasons and there are multiple risk factors which can increase its severity.The most important causal agent of bronchiolitis is the respiratory syncytial virus, which is transmitted through nasal secretions. The clinical picture begins with symptoms of the upper Keywords:Bronchiolitis respiratory syncytial viruses epidemiology hypertonic saline solution.* Autor para correspondencia. Nicolás Estrada

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Variability in Inpatient Management of Children Hospitalized With Bronchiolitis

Cited by 58 publications

References 37 publications

Discharge Criteria for Bronchiolitis

Discharge Criteria for Bronchiolitis

Improving Evidence Based Bronchiolitis Care

Bronquiolitis

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