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Marked variability observed in inpatient management of bronchiolitis in three Finnish hospitals
Varpu Elenius1, Eija Bergroth2, Petri Koponen3
1Department of Paediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland.
Insights
Clinical management for infant bronchiolitis varied significantly across Finnish hospitals, highlighting a need for evidence-based guidelines. This study examined practice variations in pediatric care for young children with bronchiolitis.
Area of Science:
- Pediatrics
- Respiratory Medicine
- Health Services Research
Background:
- Infants hospitalized for bronchiolitis often receive treatments lacking research support.
- Significant variations in clinical practice for pediatric bronchiolitis have been observed.
Purpose of the Study:
- To investigate practice variations in the management of bronchiolitis among Finnish children under two years old.
- To assess differences in diagnostic testing and therapeutic interventions for bronchiolitis based on hospital and case definition.
Main Methods:
- Prospective, multicenter cohort study in three Finnish university hospitals (2008-2010).
- Review of hospital medical records for 408 infants aged under two.
- Data analysis stratified by strict (infants <12 months, no prior wheezing) and loose (12-23 months or history of wheezing) bronchiolitis definitions.
Main Results:
- Clinical management of bronchiolitis varied considerably between the three hospitals.
- Variations were noted in the use of complete blood counts, chest X-rays, intravenous fluids, nebulized epinephrine, salbutamol, and corticosteroids.
- Differences in practice were evident when stratifying by strict versus loose definitions of bronchiolitis.
Conclusions:
- Considerable variation exists in the clinical management of infant bronchiolitis in Finland.
- The study underscores the need for greater adherence to evidence-based guidelines for bronchiolitis treatment.
- Standardization of care is recommended to improve outcomes for children with bronchiolitis.
Aim:
Infants hospitalised for bronchiolitis undergo examinations and treatments not supported by current research evidence and we investigated practice variations with regard to Finnish children under the age of two.
Methods:
This prospective, multicentre cohort study was conducted in paediatric units in three university hospitals in Finland from 2008 to 2010. Hospital medical records were reviewed to collect data on clinical course, testing and treatment. Data were analysed separately for children meeting our strict definition of bronchiolitis, aged under 12 months without a history of wheezing, and a loose definition, aged 12-23 months or with a history of wheezing.
Results:
The median age of the 408 children was 8.1 months. Clinical management varied between the three hospitals when stratified by strict and loose bronchiolitis subgroup definitions: complete blood counts ranged from 15-95% vs 16-94%, respectively, and the other measures were chest x-ray (16-91% vs 14-72%), intravenous fluids (2-47% vs 2-41%), use of nebulised epinephrine (10-84% vs 7-50%), use of salbutamol (18-21% vs 13-84%) and use of corticosteroids (6-23% vs 60-76%).
Conclusion:
The clinical management of bronchiolitis varied considerably with regard to the three hospitals and the two definitions of bronchiolitis. A stronger commitment to evidence-based bronchiolitis guidelines is needed in Finland.