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Eur J Pediatr. 2012 Jul;171(7):1109-19. doi: 10.1007/s00431-012-1683-y. Epub 2012 Feb 21.

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

Collaborators (188)

Gómez G, Garrido J, Servilla JE, Escobar I, Sánchez F, Tudela L, Valverde A, Rodríguez M, Faba I, Crespo M, Laita JA, Costa R, Calleja C, Jiménez MC, Delgado R, Salas Y, Benito M, Suárez V, Balbuena M, Mora Gandarillas I, Pérez Candás JI, Pérez M, Rodríguez C, Ruisánchez A, Meana B, Encinas A, Aurrecoechea B, Adaro M, Sánchez R, Fernández Francés M, Franco I, Ballesteros S, Martín M, López AJ, López M, Norniella C, Méndez C, Fernández E, Antuña J, Suárez J, Treviño S, Caro F, Todorcevic S, García Luzardo MR, Sanz A, Pérez M, Granda L, Belmonte E, de Armentia S, Sánchez R, Pérez L, López S, García I, Gutiérrez AB, García J, Alonso I, Villamuriel CS, Cano Garcinuño A, Leal C, Andrés de Llano JM, Alonso JE, Porro B, Jiménez MC, Amores MJ, Sánchez M, López Ávila J, Ruano A, Ruano J, de Dios Martín B, de Miguel S, Granados S, Ayestaran O, Conde Redondo F, del Río López A, del Pozo V, Malfaz F, Martín C, Martínez B, Valderrábano L, Gutiérrez C, Vázquez Fernández ME, Vara MM, García P, Vicente S, Figuero M, Hernández MJ, Pérez MJ, Sangrador C, Delgado AF, Testa A, Ortega Casanueva C, Aragón G, Galdeano P, Teruel G, Fernández Ureña S, Hernández M, Guerra F, Sabaté J, Marina RB, Gimeno E, Alvarez JC, Pablos C, Prat S, Mayol i Canals L, Gordillo C, de Campos G, Moraleda MJ, Martín T, Redondo A, Sanguino A, Sepulcre B, Serra B, Tosao A, Olivares J, Rico Uriós CP, Mayor MC, Tarí MJ, Fuggini MS, Almenara L, Roble E, Melnikova A, Riva M, Gutiérrez A, Degtyareva I, Olmo V, Burguera F, Ricote JL, de Dios J, Juesas C, Ferrer E, Gimeno MJ, Pellicer J, Sansano I, García M, Plaza Miranda A, Medina C, de Laviada Mulero T, Zamora P, Monzó M, Málaga CM, Valdés JJ, Espadero D, Ferreiro ME, García Fernández E, Villar AI, Barca RM, Tapia M, Veiga A, Torres F, Torres N, Collazo L, Quintela Fernández MI, Fernández Cebrián SA, Pérez MJ, Vadillo González F, Andrés AG, Manchado P, Legerén C, Castañeda M, Iglesias Meleiro JM, González Colmenero E, Cortizas J, Martínez E, Conde A, del Pilar CS, Rodríguez P, Cortés Rico O, Rodrigo M, de Luna G, Mate MM, Marcos M, Iguaran C, Giralda A, Velasco F, Oliveri L, Álvarez JL, León V, Rodríguez M, Guerrero MM, Pardillo R, Cítores A, Blecua M, Murua J, Aramburu FJ, Echenique I, Arcelus E, Díaz C, Sánchez Echaniz J.

Author information

  • 1Pediatric Service, Hospital Virgen de la Concha, C/Jardines Eduardo Barrón 1 bis 3°, 49018, Zamora, Spain. cochoas@meditex.es

Abstract

Most patients with acute bronchiolitis have a mild course and only require outpatient care. However, some of them have to go to emergency departments, because they have respiratory distress or feeding problems. There, they frequently receive diagnostic and therapeutic procedures. We want to know the variability and appropriateness of these procedures. A cross-sectional study (October 2007 to March 2008) was carried out on 2,430 diagnosed cases of bronchiolitis in hospital emergency departments, which required no hospitalization. An analysis of the appropriateness of the treatments was made in 2,032 cases gathered in ten departments with at least 100 cases, using as criterion the recommendations of a consensus conference. We estimated the adjusted percentages of each department. Most of the bronchiolitis were mild, in spite that they underwent multiple diagnostic and therapeutic procedures. In the acute phase, different treatments were used: inhaled beta 2 agonists (61.4%), antipyretics (17.1%), oral steroids (11.3%), and nebulized adrenaline (9.3%). In the maintenance phase, the most common treatments were: inhaled beta 2 agonists (50.5%), oral steroids (17%), oral beta 2 agonists (14.9%), and antibiotics (6.1%). The 64% of the treatments used in the acute phase and the 55.9% in the maintenance phase were considered inappropriate in the appropriateness analysis; a great heterogeneity among centers was found.

CONCLUSIONS:

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.

PMID:
22350372
[PubMed - indexed for MEDLINE]
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