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Variations in bronchiolitis management between five New Zealand hospitals: can we do better?
A M Vogel1, D R Lennon, J E Harding
1Department of Paediatrics, South Auckland Clinical School, University of Auckland, Starship Children's Hospital, Auckland, New Zealand. alvogel@middlemore.co.nz
Objectives:
To determine the current management of bronchiolitis by five major New Zealand hospitals and to identify areas for improvement.
Methods:
Lists of infants under 1 year of age admitted with bronchiolitis during 1998 were obtained from the casemix offices of the five largest New Zealand hospitals with paediatric services. Hospital records from a random sample of these admissions were reviewed.
Results:
Out of the 409 infants admitted overnight, 8% had been born less than or=32 weeks gestation and 53% were aged younger than 6 months. Overall, 59% received oxygen, 21% had nasogastric fluids, 22% had intravenous fluids, 34% were prescribed antibiotics, 42% received bronchodilators and 60% had a chest radiograph. Respiratory secretions were collected for viral studies from 58% of infants and, in 59%, respiratory syncytial virus was detected. Significant variations in management were detected between hospitals. The overall proportion of infants requiring oxygen, intravenous or nasogastric fluids (65%) was significantly higher than that found in a 1986-1988 Christchurch study where only 25% received one or more of these interventions (P < 0.001).
Conclusions:
Opportunities exist to rationalize bronchiolitis management in New Zealand with potential cost savings, particularly by reducing the number of chest radiographs and prescribing of unnecessary antibiotics and bronchodilators.
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