Assessing the impact of national guidelines on the management of children hospitalized for acute bronchiolitis.

BACKGROUND

Acute bronchiolitis is a common illness accounting for $500 million annually in hospitalizations. Despite the frequency of bronchiolitis, its diagnosis and management is variable. To address this variability, the American Academy of Pediatrics (AAP) published an evidence-based practice management guideline for bronchiolitis in 2006.

OBJECTIVE

Assess for changes in physician behavior in the management of bronchiolitis before and after publication of the 2006 AAP bronchiolitis guideline.

METHODS

A retrospective chart review was performed at two academic medical centers of children <24 months of age admitted to the hospital with a primary or secondary discharge diagnosis of bronchiolitis. Pre-guideline charts were gathered from 2004 to 2005 and post-guideline charts from 2007 to 2008. Evaluation and therapeutic interventions prior to and during hospitalization were analyzed. Data were analyzed using chi-squared analysis for categorical variables, Mann-Whitney testing for continuous variables.

RESULTS

One thousand two hundred thirty-three patients met inclusion criteria. Diagnostic laboratory testing rates did not decline after guideline publication. The number of chest X-rays obtained decreased from 72.9% to 66.7% post-guidelines (P = 0.02). Fewer children received a trial of racemic epinephrine (17.8% vs. 12.2%, P = 0.006) or albuterol (81.6% vs. 72.6%, P < 0.0001) post-guidelines, and physicians more often discontinued albuterol when documented ineffective in the post-guidelines period (28.6% vs. 78.9%, P < 0.0001). Corticosteroid use in children without a history of RAD or asthma dropped post-guidelines (26.5% vs. 17.5%, P < 0.0001).

CONCLUSIONS

A modest change in physician behavior in the inpatient management of bronchiolitis was seen post-guidelines. Additional health care provider training and education is warranted to reduce unnecessary interventions and healthcare resources use.