Practice Variation in Acute Bronchiolitis: A Pediatric Emergency Research Networks Study

Area of Science:

• Pediatrics
• Infectious Diseases
• Respiratory Medicine

Background:

• Bronchiolitis is a common viral respiratory infection in infants.
• Existing studies have not adequately characterized the use of evidence-based supportive therapies (EBSTs) in hospitalized infants with bronchiolitis.
• Variations in care delivery may impact patient outcomes.

Purpose of the Study:

• To assess intersite and internetwork variation in the administration of EBSTs for hospitalized infants diagnosed with bronchiolitis.
• To identify patient characteristics associated with receiving EBSTs.
• To examine the influence of hospital site and research network on treatment variations.

Main Methods:

• Retrospective cohort study involving 3725 infants under 12 months with bronchiolitis across 38 pediatric emergency departments in international research networks.
• Primary outcome: receipt of at least one EBST (parenteral fluids, oxygen, or airway support) during hospitalization.
• Multivariable analysis to identify predictors of EBST use and variations by site and network.

Main Results:

• Of 1466 hospitalized infants, 69.8% received EBSTs, with significant variation by hospital site (range 6%-99%).
• Patient factors like apnea, dehydration, and respiratory distress predicted EBST use.
• Pharmacotherapy and radiography use varied significantly by site and network, with notable differences between countries.

Conclusions:

• Over 30% of hospitalized infants with bronchiolitis did not receive EBSTs.
• Hospital site is a major determinant of care variation for all studied outcomes.
• Research networks also influenced the use of pharmacotherapy and radiography, suggesting a need for standardized treatment protocols.