Molloy Matthew J, Tamaroff Jaclyn, McDaniel Lauren, Genies Marquita C
Johns Hopkins University, Baltimore, MD, USA.
Clin Pediatr (Phila). 2019 Oct;58(11-12):1284-1290. doi: 10.1177/0009922819852982. Epub 2019 Jun 5.
Bronchiolitis remains a leading cause of hospitalization of infants. Despite evidence-based recommendations, wide variation in practice remains. A pre-post educational intervention was implemented to improve adherence to bronchiolitis guidelines in emergency and inpatient settings. Among children meeting inclusion criteria (136 pre-intervention, 185 post-intervention), emergency department (ED) bronchodilator use decreased by 64% ( < .001). Steroid use decreased by 71% ( = .002). There was no difference in viral testing, antibiotic use, or chest radiograph acquisition. No differences were seen in the inpatient setting. There was no difference in rate of intensive care unit transfer or length of stay. Post-intervention, children were less likely to receive a bronchodilator in the ED (odds ratio [OR] = 0.15, < .001). Children with a family history of asthma were more likely to receive a bronchodilator in the ED (OR = 4.25, < .001). Targeted education across settings contributed to reducing bronchodilator use in the ED. Family history appeared to influence medical decision making.
