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Bronchiolitis management by the Belgian paediatrician: discrepancies between evidence-based medicine and practice
1Service de Pédiatrie Clinique de Mont-Godinne Université Catholique de Louvain Avenue Thérasse 5530 Yvoir, Belgium. Georges.Debilderling@pedi.ucl.ac.be
Insights
Belgian pediatricians frequently use unproven therapies for infant bronchiolitis, including bronchodilators and antibiotics. National guidelines are recommended to standardize care and reduce costs associated with this common childhood respiratory illness.
Area of Science:
- Pediatrics
- Respiratory Medicine
- Public Health
Background:
- Bronchiolitis lacks therapies with proven efficacy, leading to inconsistent management strategies globally.
- Variations in bronchiolitis treatment exist between countries and healthcare settings.
Purpose of the Study:
- To assess the current management practices for bronchiolitis among Belgian pediatricians.
- To identify patterns in the prescription of therapies and admission criteria for bronchiolitis.
Main Methods:
- A questionnaire survey was distributed to active Belgian pediatricians, achieving over 40% response rate.
- Data collected included information on the use of bronchodilators, antibiotics, corticosteroids, physiotherapy, admission criteria, and diagnostic tools like pulse oximetry.
- Logistic regression analysis was employed to identify factors influencing prescription patterns.
Main Results:
- High rates of unproven therapies were reported: bronchodilators (74.7%-77.2%), physiotherapy (76.2%-85.6%), and antibiotics (63.8%-74.4%) in inpatient and outpatient settings.
- Corticosteroids were more frequently used in hospitals (54.3%) than outpatient settings (17.0%).
- Significant variations were observed in admission criteria, including minimal age and oxygen saturation thresholds, with one-third of respondents not using pulse oximetry.
Conclusions:
- Belgian pediatricians continue to utilize numerous therapies for bronchiolitis lacking proven effectiveness.
- The study highlights the need for national guidelines to standardize bronchiolitis management.
- Implementing guidelines could lead to reduced healthcare costs and improved patient outcomes.
Unlabelled:
There is no therapy with proven effect on bronchiolitis outcome. This leads to large variations in its management between different countries. In order to evaluate how this disease was managed in our country, a questionnaire was sent to all Belgian paediatricians. With a response rate above 40% of active paediatricians, we found that bronchodilators (74.7% vs. 77.2%), physiotherapy (76.2% vs. 85.6%) and antibiotics (63.8% vs. 74.4%) were still largely prescribed in in- and outpatient settings respectively, corticosteroids (orally or intravenously) being prescribed more often in hospitals (54.3% vs. 17.0%). There were also some variations in admission criteria (minimal age 2 months (75%) to 6 months (8.2%), lower limit for oxygen saturation: 90% (21.5%) to 95% (26.5%)) and 1/3 of the respondents did not use pulse oxymetry to evaluate hypoxaemia in infants with bronchiolitis. Logistic regression analyses allowed us to identify patterns of prescription based on age, type and level of activity and language.
Conclusion:
Many therapies with no proven effect are still used by Belgian paediatricians to treat children with bronchiolitis. Based on these results, we believe that publishing national guidelines will allow a reduction in the cost associated with this disease.