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Pediatr Pulmonol. 2014 Jul;49(7):688-94. doi: 10.1002/ppul.22835. Epub 2013 Jul 19.

Assessing the impact of national guidelines on the management of children hospitalized for acute bronchiolitis.

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1
Division of Infectious Diseases, Children's Mercy Hospital, Kansas City, MO; University of Missouri-Kansas City School of Medicine, Kansas City, MO.

Abstract

BACKGROUND:

Acute bronchiolitis is a common illness accounting for $500 million annually in hospitalizations. Despite the frequency of bronchiolitis, its diagnosis and management is variable. To address this variability, the American Academy of Pediatrics (AAP) published an evidence-based practice management guideline for bronchiolitis in 2006.

OBJECTIVE:

Assess for changes in physician behavior in the management of bronchiolitis before and after publication of the 2006 AAP bronchiolitis guideline.

METHODS:

A retrospective chart review was performed at two academic medical centers of children <24 months of age admitted to the hospital with a primary or secondary discharge diagnosis of bronchiolitis. Pre-guideline charts were gathered from 2004 to 2005 and post-guideline charts from 2007 to 2008. Evaluation and therapeutic interventions prior to and during hospitalization were analyzed. Data were analyzed using chi-squared analysis for categorical variables, Mann-Whitney testing for continuous variables.

RESULTS:

One thousand two hundred thirty-three patients met inclusion criteria. Diagnostic laboratory testing rates did not decline after guideline publication. The number of chest X-rays obtained decreased from 72.9% to 66.7% post-guidelines (P = 0.02). Fewer children received a trial of racemic epinephrine (17.8% vs. 12.2%, P = 0.006) or albuterol (81.6% vs. 72.6%, P < 0.0001) post-guidelines, and physicians more often discontinued albuterol when documented ineffective in the post-guidelines period (28.6% vs. 78.9%, P < 0.0001). Corticosteroid use in children without a history of RAD or asthma dropped post-guidelines (26.5% vs. 17.5%, P < 0.0001).

CONCLUSIONS:

A modest change in physician behavior in the inpatient management of bronchiolitis was seen post-guidelines. Additional health care provider training and education is warranted to reduce unnecessary interventions and healthcare resources use.

KEYWORDS:

2006 AAP guidelines; physician behavior; practice management

PMID:
23868897
DOI:
10.1002/ppul.22835
[Indexed for MEDLINE]

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