[Study of variability in the management of acute bronchiolitis in Spain in relation to age of patients. National multicenter study (aBREVIADo project)].

INTRODUCTION

There are many studies on the controversial issues involved in the management of acute bronchiolitis (AB). The aim of this multicenter nationwide study in Spain was to find out the variability in the management of AB in various areas of clinical care (primary care, emergency and hospitalization) and to analyze the impact of patient age on diagnostic and therapeutic management.

MATERIAL AND METHODS

A cross-sectional observational study (from October 2007 to March 2008) of all cases of BA (McConnochie criteria) treated in a sample of 31 hospitals and 60 health or primary care centers in 12 autonomous regions in Spain. A questionnaire was designed to collect study variables (general information, symptoms, risk factors, diagnostic tests and treatments) and to make a comparison of variables by age groups (newborns, 1-3 months, 3-12 months and >12 months).

RESULTS

A total of 5647 cases of AB (51.2% from emergency services, 28.9% from hospitalization, 18.3% from primary care and 1.6% from ICU), whose average age was 0.34 years (95%CI 0.32 to 0.35), with 6.6% under 1 month, 23.5% between 1 and 3 months, 60.6% from 3 to 12 months and 522 over 12 months. There is an important use of diagnostic and therapeutic procedures not recommended in clinical practice guidelines. We also found differences related to age: younger infants showed an increased risk of admission, clinical differences (greater presence of rhinitis, vomiting, refusal of feedings, apnea and septic appearance and less fever and night cough; more tachypnea, retractions, hypoventilation and impaired consciousness, and lower presence of wheezing), increased number of diagnostic tests (oxygen saturation, chest x-ray, RSV test, CBC, etc.) and differences in patterns of treatment (less use of all medications before diagnosis and the maintenance phase; in the acute phase, increased use of epinephrine and parenteral corticosteroids and lower use of bronchodilators and oral corticosteroids, and more frequent use of supplemental oxygen, intravenous fluids, intravenous antibiotics, nasal washings, respiratory aspiration, chest physiotherapy, assisted ventilation and heliox).

CONCLUSIONS

There are discrepancies between routine practice and evidence-based management of AB in Spain (both inpatient and outpatient). There is a high percentage of cases in which diagnostic tests and therapeutic interventions (of unproven effectiveness and usefulness in the BA) are performed, where the use is higher in younger infants.