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Factors associated with nonadherence to the American Academy of Pediatrics 2014 bronchiolitis guidelines: A
Laure F Pittet1,2, Alban Glangetas3, Constance Barazzone-Argiroffo4
1Division of General Pediatrics, Department of Pediatrics, Gynecology & Obstetrics, University Hospitals of Geneva and University of Geneva's Faculty of Medicine, Geneva, Switzerland.
Insights
The American Academy of Pediatrics guideline reduced bronchiolitis interventions. However, older, atopic children with wheezing and ICU infants still receive non-evidence-based treatments, indicating a need for further research in these populations.
Area of Science:
- Pediatrics
- Respiratory Medicine
- Clinical Guidelines
Background:
- The American Academy of Pediatrics (AAP) guideline for bronchiolitis management aims to reduce unnecessary interventions and healthcare costs.
- Despite guideline implementation, data on patient subgroups receiving interventions remain limited.
- Identifying factors associated with nonadherence is crucial for optimizing care.
Purpose of the Study:
- To identify factors associated with nonadherence to AAP bronchiolitis management guidelines.
- To compare intervention rates pre- and post-guideline implementation in infants.
- To assess adherence to achievable benchmarks of care.
Main Methods:
- Single-center retrospective study comparing bronchiolitis management in infants (<1 year) before (2010-2012) and after (2015-2018) AAP guideline adoption.
- Analysis of interventions including bronchodilators, oral corticosteroids, antibiotics, and chest X-rays.
- Comparison of prescription rates against achievable benchmarks.
Main Results:
- Post-guideline, bronchodilators were more frequently given to older (>6 months), atopic children with wheezing.
- Oral corticosteroids were more often prescribed to older infants with wheezing.
- Antibiotics and chest X-rays were more frequent in intensive care unit (ICU) admitted children.
- All intervention rates remained below achievable benchmarks.
Conclusions:
- Older, atopic children with wheezing and ICU-admitted infants are more likely to receive non-evidence-based interventions for bronchiolitis.
- These specific patient profiles are often excluded from clinical trials and not fully addressed by current guidelines.
- Further research is needed to determine the benefits of bronchiolitis interventions in these understudied populations.
Abstract:
The latest guideline from the American Academy of Pediatrics for the management of bronchiolitis has helped reduce unnecessary interventions and costs. However, data on patients still receiving interventions are missing. In patients with acute bronchiolitis whose management was assessed and compared with current achievable benchmarks of care, we aimed to identify factors associated with nonadherence to guideline recommendations. In this single-centre retrospective study the management of bronchiolitis pre-guideline (Period 1: 2010 to 2012) was compared with two periods post-guideline (Period 2: 2015 to 2016, early post-guideline; and Period 3: 2017 to 2018, late post-guideline) in otherwise healthy infants aged less than 1 year presenting at the Children's University Hospitals of Geneva (Switzerland). Post-guideline, bronchodilators were more frequently administered to older (>6 months; OR 25.8, 95%CI 12.6-52.6), and atopic (OR 3.5, 95%CI 1.5-7.5) children with wheezing (OR 5.4, 95%CI 3.3-8.7). Oral corticosteroids were prescribed more frequently to older (>6 months; OR 5.2, 95%CI 1.4-18.7) infants with wheezing (OR 4.9, 95% CI 1.3-17.8). Antibiotics and chest X-ray were more frequently prescribed to children admitted to the intensive care unit (antibiotics: OR 4.2, 95%CI 1.3-13.5; chest X-ray: OR 19.4, 95%CI 7.4-50.6). Latest prescription rates were all below the achievable benchmarks of care. In summary, following the latest American Academy of Pediatrics guideline, older, atopic children with wheezing and infants admitted to the intensive care unit were more likely to receive nonevidence-based interventions during an episode of bronchiolitis. These patient profiles are generally excluded from bronchiolitis trials, and therefore not specifically covered by the current guideline. Further research should focus on the benefit of bronchiolitis interventions in these particular populations.
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