Related Experiment Video
Updated: Apr 20, 2026
Bronchial Thermoplasty: A Novel Therapeutic Approach to Severe Asthma
Published on: November 4, 2010
Variability in inpatient management of children hospitalized with bronchiolitis
Charles G Macias1, Jonathan M Mansbach2, Erin S Fisher3
1Department of Pediatrics, Section of Emergency Medicine, and Center for Clinical Effectiveness, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex.
Insights
Hospital variations in diagnostic testing and management for pediatric bronchiolitis are significant and not explained by patient factors. Standardizing care for bronchiolitis is crucial for improving outcomes.
Area of Science:
- Pediatric Medicine
- Respiratory Illness
- Healthcare Quality Improvement
Background:
- Bronchiolitis is a common respiratory infection in young children.
- Inpatient management of bronchiolitis involves diagnostic testing and various interventions.
- Variability in clinical practice can impact patient outcomes and healthcare costs.
Purpose of the Study:
- To assess hospital-level variability in diagnostic testing and management for pediatric bronchiolitis.
- To determine if patient characteristics explain observed practice variations.
- To inform strategies for standardizing bronchiolitis care.
Main Methods:
- Prospective, multicenter observational study of 1715 children (<2 years) hospitalized with bronchiolitis.
- Evaluated variability in diagnostic tests (CBC, chest radiographs) and interventions (bronchodilators, corticosteroids, antibiotics, IV placement).
- Used intraclass correlation coefficients (ICCs) to quantify hospital-level variability, adjusting for patient demographics and clinical factors.
Main Results:
- Significant hospital-level variations were found in the use of diagnostic tests and interventions.
- Proportions varied widely: CBC (21-75%), chest radiograph (36-85%), bronchodilators (19-91%), corticosteroids (8-44%), antibiotics (17-43%), IV placement (38-93%).
- Adjusting for patient characteristics did not substantially alter the hospital-attributable variability.
Conclusions:
- Wide variations in diagnostic and management practices for pediatric bronchiolitis exist across hospitals.
- These variations are not explained by differences in patient demographics or clinical severity.
- Standardization of care through quality improvement initiatives is recommended to reduce unwarranted practice variation.
Objective:
To determine the variability between hospitals in diagnostic testing and management interventions for children with bronchiolitis admitted to inpatient wards and identify its association with patient characteristics.
Methods:
A prospective, multicenter (16 hospitals), multiyear (2007-2010) observational study of children (age <2 years) hospitalized with bronchiolitis. Outcomes included variability in diagnostic testing (complete blood count, chest radiographs) and medications or interventions (bronchodilator, systemic corticosteroid, antibiotic, IV placement) by hospital. A modified Respiratory Distress Severity Score was utilized to assess severity of illness. For all outcomes, intraclass correlation coefficient (ICC) was calculated from a model to estimate the random effects of hospital without added covariates and compared to ICCs from a second model that adjusted for demographic and clinical patient characteristics. A second unadjusted and adjusted model was created for age ≥ 2 months.
Results:
Of 2207 subjects, 1715 were identified as admitted to inpatient wards. We observed wide variations in the proportion of patients who received diagnostic testing (complete blood count 21-75%, chest radiograph 36-85%) and medications/interventions (bronchodilators 19-91%, systemic corticosteroids 8-44%, antibiotics 17-43%, IV placement 38-93%). Adjusting for demographic and clinical patient characteristics did not materially affect the proportion of variability attributable to hospitals (differences in ICCs with and without model adjustment <4%).
Conclusions:
Wide variations in diagnostic test utilization and management interventions seen among children with bronchiolitis treated on the inpatient wards at 16 US hospitals were not attributable to demographic or clinical patient characteristics. These results further support efforts to standardize care for bronchiolitis through active quality improvement strategies.
Related Concept Videos
01:28Pneumonia IV: Management
Bacterial Pneumonia Treatment
For bacterial pneumonia, antibiotics serve as the cornerstone of therapy. Initial treatment often begins with empirical antibiotics, tailored to the anticipated causative organism and adjusted based on culture results. Key antibiotic choices include:
01:26COPD: Management Using Bronchodilators and Corticosteroids
01:29Acute Respiratory Failure-V
Ensure that patients are monitored continuously for their response to therapy, including changes in...
01:30Asthma-IV: Diagnostic and Management
Clinical Assessment for Asthma:
This is the first step in diagnosing and managing asthma. It includes:
01:30Asthma-IV: Nursing Management
First, in...
01:30Pneumonia V: Nursing management and Prevention
The nurse must practice strict medical asepsis and adhere to infection control guidelines to minimize healthcare-associated infections.
Enhance airway patency
Position the patient correctly to facilitate drainage of the affected lung segments. Manual or mechanical percussion and vibration can also be employed....