Electrolyte Testing Variability Among Critically Ill Children With Viral Bronchiolitis

Area of Science:

• Pediatric critical care medicine
• Clinical practice variation
• Health services research

Background:

• Viral bronchiolitis is a leading cause of pediatric hospitalization for infants.
• Rising critical bronchiolitis admissions and costs necessitate understanding care practices.
• Electrolyte testing patterns in pediatric intensive care units (PICUs) for bronchiolitis are not well-defined.

Purpose of the Study:

• To evaluate the frequency of electrolyte testing in U.S. PICUs for children with viral bronchiolitis.
• To assess the extent of variation in electrolyte testing practices across different PICUs.

Main Methods:

• Multicenter, retrospective cohort study utilizing the Pediatric Health Information System database.
• Inclusion of children admitted to PICUs with viral bronchiolitis between January 1, 2017, and December 31, 2021.
• Primary outcomes: rate of any electrolyte testing and rate of multiple electrolyte testing per hospitalization.

Main Results:

• Electrolyte testing was performed in 79% of 23,776 patient encounters.
• Significant between-hospital variation observed in both initial (32% of variation) and repeat testing (44% of variation).
• Among tested patients, 80% received multiple tests, while 20% received only a single test.

Conclusions:

• Substantial national variation exists in electrolyte testing practices for PICU patients with viral bronchiolitis.
• Heterogeneity in current practice highlights the need for further research.
• Future studies should explore clinical context to define optimal electrolyte testing strategies and their relation to patient outcomes.