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Pediatrics. 2017 Dec;140(6). pii: e20170842. doi: 10.1542/peds.2017-0842.

Practice Variation in Acute Bronchiolitis: A Pediatric Emergency Research Networks Study.

Author information

1
Division of Paediatric Emergency Medicine and.
2
The Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ontario, Canada.
3
University of Toronto, Toronto, Ontario, Canada.
4
Emergency Department, Royal Children's Hospital, Murdoch Children's Research Institute, and University of Melbourne, Melbourne, Australia.
5
Emergency Department, Starship Children's Hospital, and University of Auckland, Auckland, New Zealand.
6
Sections of Pediatric Emergency Medicine.
7
Gastroenterology.
8
Pediatric Emergency Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas.
9
Section of Pediatric Emergency Medicine, Hasbro Children's Hospital and Section of Pediatric Emergency Medicine, Rhode Island Hospital, Providence, Rhode Island.
10
Department of Pediatrics, Hospital de Santa Maria and Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, Instituto de Medicina Molecular, University of Lisbon, Lisbon, Portugal.
11
Division of Pediatric Emergency Medicine, University of Ottawa and Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
12
Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
13
Pediatric Emergency Department, Bristol Royal Hospital for Children and Faculty of Health and Life Sciences, University of the West of England, Bristol, United Kingdom.
14
Emergency Medicine, and.
15
Physiology and Pharmacology, Department of Pediatrics, Alberta Children's Hospital Research Institute and Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
16
Centre hospitalier universitaire Sainte-Justine, University of Montreal, Montreal, Quebec, Canada.
17
Pediatric Emergency Medicine, School of Medicine, Washington University in St Louis, St Louis, Missouri.
18
Manitoba Institute of Child Health, University of Manitoba, Winnipeg, Manitoba, Canada.
19
Department of Pediatrics, Children's Hospital Colorado, Aurora, Colorado.
20
Pediatric Emergency Department, Cruces University Hospital, Barakaldo, Bizkaia, Spain.
21
Emergency Department, Children's Hospital of Minnesota, Minneapolis, Minnesota; and.
22
Departments of Emergency Medicine and.
23
Pediatrics, Davis School of Medicine, University of California, Sacramento, California.

Abstract

BACKGROUND AND OBJECTIVES:

Studies characterizing hospitalizations in bronchiolitis did not identify patients receiving evidence-based supportive therapies (EBSTs). We aimed to evaluate intersite and internetwork variation in receipt of ≥1 EBSTs during the hospital management of infants diagnosed with bronchiolitis in 38 emergency departments of pediatric emergency research networks in Canada, the United States, Australia, New Zealand, the United Kingdom, Ireland, Spain, and Portugal. We hypothesized that there would be significant variation, adjusted for patient characteristics.

METHODS:

Retrospective cohort study of previously healthy infants aged <12 months with bronchiolitis. Our primary outcome was that hospitalization occurred with EBST (ie, parenteral fluids, oxygen, or airway support).

RESULTS:

Out of 3725 participants, 1466 (39%) were hospitalized, and 1023 out of 1466 participants (69.8%) received EBST. The use of EBST varied by site (P < .001; range 6%-99%, median 23%), but not by network (P = .2). Significant multivariable predictors and their odds ratios (ORs) were as follows: age (0.9), oxygen saturation (1.3), apnea (3.4), dehydration (3.2), nasal flaring and/or grunting (2.4), poor feeding (2.1), chest retractions (1.9), and respiratory rate (1.2). The use of pharmacotherapy and radiography varied by network and site (P < .001), with respective intersite ranges 2% to 79% and 1.6% to 81%. Compared with Australia and New Zealand, the multivariable OR for the use of pharmacotherapy in Spain and Portugal was 22.7 (95% confidence interval [CI]: 4.5-111), use in Canada was 11.5 (95% CI: 3.7-36), use in the United States was 6.8 (95% CI: 2.3-19.8), and use in the United Kingdom was 1.4 (95% CI: 0.4-4.2). Compared with United Kingdom, OR for radiography use in the United States was 4.9 (95% CI 2.0-12.2), use in Canada was 4.9 (95% CI 1.9-12.6), use in Spain and Portugal was 2.4 (95% CI 0.6-9.8), and use in Australia and New Zealand was 1.8 (95% CI 0.7-4.7).

CONCLUSIONS:

More than 30% of infants hospitalized with bronchiolitis received no EBST. The hospital site was a source of variation in all study outcomes, and the network also predicted the use of pharmacotherapy and radiography.

PMID:
29184035
DOI:
10.1542/peds.2017-0842
[Indexed for MEDLINE]
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