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Adherence to national paediatric bronchiolitis management guidelines and impact on emergency department resource
Kate Maki1,2, Hawmid Azizi1, Prabhjas Hans1
1Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia.
Insights
Nonrecommended pharmacology in bronchiolitis treatment did not increase return visits but prolonged paediatric emergency department stays. Salbutamol and corticosteroid use significantly increased length of stay.
Area of Science:
- Pediatric Emergency Medicine
- Pharmacology
- Respiratory Illness
Background:
- Bronchiolitis is a common pediatric respiratory infection.
- National guidelines recommend specific pharmacological approaches for bronchiolitis management.
- Nonadherence to these guidelines may impact healthcare utilization.
Purpose of the Study:
- To evaluate the association between using nonrecommended medications (salbutamol and corticosteroids) for bronchiolitis and healthcare utilization.
- To assess the impact on return emergency department visits (RTED) and paediatric emergency department (PED) length of stay (LOS).
Main Methods:
- Retrospective case-control study of 185 infants (≤12 months) diagnosed with bronchiolitis.
- Compared infants receiving nonrecommended pharmacology with those adhering to guidelines.
- Used logistic and multivariable linear regression to analyze RTED and PED LOS.
Main Results:
- 39% of participants received nonrecommended pharmacology.
- Nonrecommended pharmacology was not associated with an increased odds of RTED (OR: 0.98, 95% CI: 0.47 to 2.03).
- Use of salbutamol and corticosteroids independently increased PED LOS by 58.3 and 116.7 minutes, respectively (P<0.01).
Conclusions:
- Nonadherence to national bronchiolitis medication guidelines did not lead to more return visits.
- The use of salbutamol and corticosteroids in bronchiolitis is associated with longer emergency department stays.
- This suggests a need to reinforce guideline adherence for medication use in pediatric bronchiolitis.
Objective:
To evaluate the association between the use of nonrecommended pharmacology (salbutamol and corticosteroids) per national bronchiolitis guidelines, either during the index visit or at discharge, and system utilization measures (frequency of return visits [RTED] and on paediatric emergency department [PED] length of stay [LOS]).
Study Design:
We conducted a retrospective case control study of 185 infants (≤12 months old) who presented to the PED between December 2014 and April 2017 and discharged home with a clinical diagnosis of bronchiolitis. Inclusion criteria included ≥ 1 viral prodromal symptom and ≥ 1 physical exam finding of respiratory distress. Cases were defined as infants who had ≥ 1 RTED within 7 days of their index visit and controls were matched for age and acuity but without RTED. Logistic regression analysis and multivariable linear regression were used to assess the odds of RTED and PED LOS associated with nonadherence to pharmaceutical recommendations per AAP and CPS bronchiolitis guidelines.
Results:
Use of nonrecommended pharmacology per national bronchiolitis guidelines was documented among 39% of the 185 study participants. Adjusting for acuity of index visit, age, severe tachypnea, oxygen desaturation, and dehydration, use of nonrecommended pharmacology was not associated with RTED (odds ratio [OR]: 0.98, 95% confidence interval [CI]: 0.47 to 2.03). Use of salbutamol and corticosteroids, however, were each independently associated with increased PED LOS (58.3 minutes [P=0.01] and 116.7 minutes [P<0.001], respectively).
Conclusion:
Nonadherence to the pharmaceutical recommendations of national bronchiolitis guidelines was not associated with RTED but salbutamol and corticosteroid use increased PED LOS.
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