Child Health Royal Aberdeen Children's Hospital, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZG, UK.
Eur J Pediatr. 2012 May;171(5):827-32. doi: 10.1007/s00431-011-1653-9. Epub 2011 Dec 23.
Bronchiolitis is a common lower respiratory tract infection of infancy where management has varied considerably in the past. The aim of the present study was to determine whether patient treatment and outcomes changed after introduction of a clinical care pathway. Infants aged up to 6 months admitted to hospital with bronchiolitis were identified as part of an annual audit of bronchiolitis management between winters 2003/2004 and 2009/2010. The primary outcome, duration of stay (DOS), was compared before and after the clinical pathway was introduced before the winter 2005/2006. There were 328 infants identified, mean age 75 days, respiratory syncitial virus was detected in 89%. After the clinical pathway was introduced, the proportion of infants prescribed salbutamol fell from 50% to 8% (p < 0.001) and ipratropium bromide from 38% to 0% (p < 0.001) but the proportion prescribed antibiotics was unchanged. The median DOS was 79 h prior to the clinical pathway and 66 h afterwards (p = 0.010) but there was no difference in days where supplemental oxygen or nasogastric feeding was required.
A clinical pathway for the management of acute bronchiolitis can be implemented in the hospital setting and the conservative approach, in particular not prescribing bronchodilators, is not associated with prolonged duration of stay.
本研究旨在确定在引入临床护理路径后，患者的治疗和结局是否发生变化。
在 2003/2004 年至 2009/2010 年冬季之间，对支气管肺炎管理进行年度审核期间，确定了年龄在 6 个月以下的因支气管肺炎住院的婴儿。主要结局是住院时间（DOS），并在临床路径引入之前，在 2005/2006 年冬季之前，与引入前进行比较。
共确定了 328 名婴儿，平均年龄为 75 天，89%的婴儿检测到呼吸道合胞病毒。引入临床路径后，沙丁胺醇的处方比例从 50%降至 8%（p<0.001），异丙托溴铵从 38%降至 0%（p<0.001），但抗生素的处方比例不变。引入临床路径前的中位 DOS 为 79 小时，引入后为 66 小时（p=0.010），但需要补充氧气或鼻胃管喂养的天数没有差异。
可以在医院环境中实施急性支气管肺炎的临床路径，保守方法，特别是不使用支气管扩张剂，与延长住院时间无关。
