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An Pediatr (Barc). 2010 Jan;72(1):4-18. doi: 10.1016/j.anpedi.2009.10.006. Epub 2009 Dec 21.

[Study of variability in the management of acute bronchiolitis in Spain in relation to age of patients. National multicenter study (aBREVIADo project)].

[Article in Spanish]

Collaborators (182)

Gámez Gómez MD, Batlles Garrido J, Cabrera Servilla E, García Escobar I, Giménez Sánchez F, Ruiz Tudela L, Fernández Valverde A, Bueno Rodríguez MG, Ramón Faba I, Praena Crespo M, Castillo Laita A, Macipe Costa R, Campos Calleja C, García Jiménez MC, Pérez Delgado R, Romero Salas Y, López Benito M, Martínez Suárez V, García Balbuena M, Mora Gandarillas I, Pérez Candás I, Cobo Ruisánchez A, Yáñez Meana B, Hernández Encinas A, Domínguez Aurrecoechea B, García Adaro M, Buznego Sánchez R, Fernández Francés M, Franco I, Ballesteros S, Benito Martín M, Mira López AJ, Fernández López M, Molinos Norniella C, Pérez Méndez C, Fernández Fernández E, Fernández Antuña J, Rodríguez Suárez J, Jiménez Treviño S, Alvarez Caro F, Todorcevic S, García Luzardo MR, Bercedo Sanz A, Cabero Pérez J, Alvarez Granda L, Pérez Belmonte E, Lapeña López de Armentia S, Morales Sánchez R, Fernández Pérez L, Alberola López S, Pérez García I, Camina Gutiérrez AB, Santos García JG, Casares Alonso I, Cano Garcinuño A, Urueña Leal C, Andrés de Llano JM, Fernández Alonso JE, Bartolomé Porro JM, Sánchez Jiménez MC, Estévez Amores MJ, Mendoza Sánchez M, López Avila J, Martín Ruano A, Martín Ruano J, de Dios Martín B, Fernández de Miguel S, Sánchez Granados JM, Serrano Ayestaran O, Conde Redondo F, del Río López A, Matías del Pozo V, Centeno Malfaz F, Alcalde Martín C, Bello Martínez B, Crespo Valderrábano L, Gutiérrez Abad C, Vázquez Fernández ME, Cortés Gabaudán A, Miguélez Vara MM, Pérez García P, García Vicente S, Prieto Figuero MA, Piorno Hernández MJ, Moro Pérez MJ, Ochoa Sangrador C, Bajo Delgado AF, Fernández Testa A, Ortega Casanueva C, Ruiz Aragón G, Aizpurua Galdeano P, Claret Teruel G, Fernández Ureña S, Méndez Hernández M, Brossa Guerra F, Fàbrega Sabaté J, Cortés Marina RB, Fortea Gimeno E, Buñuel Alvarez JC, Vila Pablos C, Uriel Prat S, Mayol i Canals L, Buhedo Gordillo C, Rinero de Campos G, Mateo Moraleda MJ, Pérez Martín T, Redondo A, Sanguino A, Sepulcre B, Serra B, Tosao A, Galiano Olivares J, Rico Uriós CP, Sirvent Mayor MC, Fernández Tarí MJ, Fuggini MS, Comino Almenara L, Bernabé Gutiérrez A, Degtyareva I, Cañadas Olmo V, Goberna Burguera F, Mestre Ricote JL, González de Dios J, Rivas Juesas C, Fabregat Ferrer E, Palomares Gimeno MJ, Colomer Pellicer J, Ubeda Sansano I, Romero García M, Plaza Miranda A, Sánchez Medina C, Alvarez de Laviada Mulero T, Barona Zamora P, Asensi Monzó M, Gómez Málaga CM, Cuervo Valdés JJ, Barroso Espadero D, Amigo Ferreiro ME, García Fernández E, García Villar AI, Romaris Barca RM, Santos Tapia M, Miras Veiga A, Martinón Torres F, Martinón Torres N, Redondo Collazo L, Quintela Fernández MI, Fernández Cebrián SA, Pita Pérez MJ, Vadillo González FJ, Andrés Andrés AG, Lago Manchado P, Lorenzo Legerén C, Berrocal Castañeda M, Iglesias Meleiro JM, González Colmenero E, Antelo Cortizas J, García Martínez E, Ruiz Conde A, González Rodríguez P, Cortés Rico O, Aparicio Rodrigo M, Orejón de Luna G, Martín Mate MM, Duelo Marcos M, Indaberea Iguaran C, Nuñez Giralda A, Muñoz Velasco F, Perdikidis Oliveri L, Montón Alvarez L, Orbe León V, Fernández Rodríguez M, Guerrero MM, Marañón Pardillo R, Peñalba Cítores A, Callén Blecua M, Korta Murua J, Mintegui Aramburu FJ, Olaciregui Echenique I, Rezola Arcelus E, González Díaz C, Sánchez Echaniz J.

Author information

1
Servicio de Pediatría, Hospital de Torrevieja, Departamento de Pediatría, Universidad Miguel Hernández, Alicante, España.

Abstract

INTRODUCTION:

There are many studies on the controversial issues involved in the management of acute bronchiolitis (AB). The aim of this multicenter nationwide study in Spain was to find out the variability in the management of AB in various areas of clinical care (primary care, emergency and hospitalization) and to analyze the impact of patient age on diagnostic and therapeutic management.

MATERIAL AND METHODS:

A cross-sectional observational study (from October 2007 to March 2008) of all cases of BA (McConnochie criteria) treated in a sample of 31 hospitals and 60 health or primary care centers in 12 autonomous regions in Spain. A questionnaire was designed to collect study variables (general information, symptoms, risk factors, diagnostic tests and treatments) and to make a comparison of variables by age groups (newborns, 1-3 months, 3-12 months and >12 months).

RESULTS:

A total of 5647 cases of AB (51.2% from emergency services, 28.9% from hospitalization, 18.3% from primary care and 1.6% from ICU), whose average age was 0.34 years (95%CI 0.32 to 0.35), with 6.6% under 1 month, 23.5% between 1 and 3 months, 60.6% from 3 to 12 months and 522 over 12 months. There is an important use of diagnostic and therapeutic procedures not recommended in clinical practice guidelines. We also found differences related to age: younger infants showed an increased risk of admission, clinical differences (greater presence of rhinitis, vomiting, refusal of feedings, apnea and septic appearance and less fever and night cough; more tachypnea, retractions, hypoventilation and impaired consciousness, and lower presence of wheezing), increased number of diagnostic tests (oxygen saturation, chest x-ray, RSV test, CBC, etc.) and differences in patterns of treatment (less use of all medications before diagnosis and the maintenance phase; in the acute phase, increased use of epinephrine and parenteral corticosteroids and lower use of bronchodilators and oral corticosteroids, and more frequent use of supplemental oxygen, intravenous fluids, intravenous antibiotics, nasal washings, respiratory aspiration, chest physiotherapy, assisted ventilation and heliox).

CONCLUSIONS:

There are discrepancies between routine practice and evidence-based management of AB in Spain (both inpatient and outpatient). There is a high percentage of cases in which diagnostic tests and therapeutic interventions (of unproven effectiveness and usefulness in the BA) are performed, where the use is higher in younger infants.

PMID:
20022571
DOI:
10.1016/j.anpedi.2009.10.006
[Indexed for MEDLINE]
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