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Inpatient care for uncomplicated bronchiolitis: comparison with Milliman and Robertson guidelines
N M Kini1, J M Robbins, M S Kirschbaum
1Center for Quality and Outcomes Management, Children's Hospital of Wisconsin, Milwaukee 53201, USA. nkini@chw.org
Archives of Pediatrics & Adolescent Medicine
|December 26, 2001
Summary
Hospitalization rates for infant bronchiolitis are high, but current treatment practices do not align with recommended 1-day stays. Interventions often continue beyond the second day, indicating a gap in care guidelines.
Area of Science:
- Pediatrics
- Respiratory Medicine
- Health Services Research
Background:
- Bronchiolitis is the most common infant lower respiratory infection.
- Hospitalization rates for bronchiolitis have significantly increased.
- Optimal treatment strategies remain debated.
Purpose of the Study:
- To compare actual clinical practice for hospitalized infants with uncomplicated bronchiolitis against established recommendations.
- To identify variations in care delivery and length of stay.
Main Methods:
- Prospective observational study conducted in 8 pediatric hospitals.
- Inclusion criteria: first-time admissions for uncomplicated bronchiolitis in infants under 1 year.
- Outcome measures: respiratory rate, interventions, discharge criteria, and length of stay.
Main Results:
- 846 infants were analyzed; most were under 6 months, nonwhite, and on Medicaid/self-pay.
- Initial interventions included supplemental oxygen (53.8%) and IV fluids (52.6%).
- Average length of stay was 2.8 days, with interventions continuing past day 2.
Conclusions:
- Observed practice patterns deviate from Milliman and Robertson's 1-day length of stay recommendations.
- No participating hospital achieved the recommended 1-day stay for bronchiolitis admissions.
- Interventions frequently extended beyond the second day of hospitalization.
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