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Drivers of Bronchodilator Use in Bronchiolitis: Analyzing Treatment Trends From Pediatric Emergency Department
Andrea Rivera-Sepulveda1,2, Timothy Maul3,4, Anna Jurlina2
1Department of Pediatrics, Division of Emergency Medicine and Urgent Care, Nemours Children's Health.
Insights
Previous bronchodilator (BD) use in children with bronchiolitis predicts future BD use during illness and emergency department (ED) visits, suggesting a cyclical pattern influenced by perceived bronchospasm.
Area of Science:
- Pediatrics
- Respiratory Medicine
- Emergency Medicine
Background:
- Bronchiolitis is a common viral respiratory infection in infants and young children.
- Bronchodilator (BD) use in bronchiolitis is controversial, with variable efficacy.
- Understanding predictors of BD use is crucial for optimizing emergency department (ED) care.
Purpose of the Study:
- To evaluate patient characteristics associated with bronchodilator (BD) use at various illness stages of bronchiolitis.
- To assess the impact of BD use on patient outcomes in the emergency department (ED).
Main Methods:
- Retrospective, cross-sectional study of 932 children (3-24 months) with bronchiolitis.
- Analysis of demographics, medical history, physical findings, and medication use.
- Multivariable logistic regression model developed to predict BD use in the ED.
Main Results:
- Prior BD use significantly increased likelihood of BD use before, during, and after ED visits.
- Older age, parental asthma history, and physical exam findings (wheezes, retractions) predicted ED BD use.
- The predictive model for ED BD use demonstrated good performance (AUC = 0.826).
Conclusions:
- A cyclical pattern of BD use exists, driven by prior use and potentially perceived bronchospasm.
- Clinical practice in ED settings may be influenced by a perceived bronchospastic phenotype in bronchiolitis.
- Further research is needed to clarify the role of BDs in bronchiolitis management.
Objectives:
This study aims to evaluate patient characteristics associated with bronchodilator (BD) use at various stages of bronchiolitis illness and evaluate corresponding patient outcomes in the emergency department (ED).
Methods:
This retrospective, cross-sectional study involves secondary data analysis from a sample of 932 children ages 3 to 24 months who received a diagnosis of bronchiolitis during an ED visit (1057 cases). Predictor variables included demographics, past medical history, family history, physical findings, medication use, and disposition. Outcomes included BD use for bronchiolitis symptoms in the pre-ED and ED settings, and associated care outcomes in the ED. Predictors of BD use in the ED with statistical significance were incorporated in a predictive multivariable logistic regression model with a training-validation split of 70% to 30%.
Results:
Children with prior BD use were significantly more likely than children without such history to receive BD treatment during their current bronchiolitis illness before the ED [odds ratio (OR): 23.7, 95% CI: 14.4-39], in the ED (OR: 2.6, 95% CI: 1.76-3.77), and as a prescription upon discharge from the ED (OR: 3.7, 95% CI: 2.49-5.58). In multivariable regression analyses, older age, parental asthma history, and wheezes and retractions on ED physical examination were significantly associated with BD use in the ED ( P <0.05). The area under the curve for the validation model with these variables was 0.826 (95% CI: 0.794-0.858).
Conclusions:
Prior BD use was associated with subsequent use during the current illness, during ED care, and subsequent prescription, forming a cyclical pattern. A perceived bronchospastic phenotype of bronchiolitis may influence clinical practice in ED settings.
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