1. International variation in evidence-based emergency department management of bronchiolitis: a retrospective cohort study
- Author
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Lirette, Marie-Pier, Kuppermann, Nathan, Finkelstein, Yaron, Zemek, Roger, Plint, Amy C, Florin, Todd Adam, Babl, Franz E, Dalziel, Stuart, Freedman, Stephen, Roland, Damian, Lyttle, Mark David, Schnadower, David, Steele, Dale, Fernandes, Ricardo M, Stephens, Derek, Kharbanda, Anupam, Johnson, David W, Macias, Charles, Benito, Javier, Schuh, Suzanne, and Networks, the Pediatric Emergency Research
- Subjects
Biomedical and Clinical Sciences ,Public Health ,Health Sciences ,Emergency Care ,Clinical Research ,Respiratory ,Infant ,Humans ,Child ,Retrospective Studies ,Hospitalization ,Bronchodilator Agents ,Bronchiolitis ,Emergency Service ,Hospital ,Dyspnea ,PAEDIATRICS ,Paediatric A&E and ambulatory care ,Paediatric infectious disease & immunisation ,Pediatric Emergency Research Networks ,Clinical Sciences ,Public Health and Health Services ,Other Medical and Health Sciences ,Biomedical and clinical sciences ,Health sciences ,Psychology - Abstract
ObjectivesWe aimed to evaluate the international variation in the use of evidence-based management (EBM) in bronchiolitis. We hypothesised that management consistent with full-EBM practices is associated with the research network of care, adjusted for patient-level characteristics. Secondary objectives were to determine the association between full-EBM and (1) hospitalisation and (2) emergency department (ED) revisits resulting in hospitalisation within 21 days.DesignA secondary analysis of a retrospective cohort study.Setting38 paediatric EDs belonging to the Paediatric Emergency Research Network in Canada, USA, Australia/New Zealand UK/Ireland and Spain/Portugal.PatientsOtherwise healthy infants 2-11 months old diagnosed with bronchiolitis between 1 January 2013 and 31 December, 2013.Outcome measuresPrimary outcome was management consistent with full-EBM, that is, no bronchodilators/corticosteroids/antibiotics, no chest radiography or laboratory testing. Secondary outcomes included hospitalisations during the index and subsequent ED visits.Results1137/2356 (48.3%) infants received full-EBM (ranging from 13.2% in Spain/Portugal to 72.3% in UK/Ireland). Compared with the UK/Ireland, the adjusted ORs (aOR) of full-EBM receipt were lower in Spain/Portugal (aOR 0.08, 95% CI 0.02 to 0.29), Canada (aOR 0.13 (95% CI 0.06 to 0.31) and USA (aOR 0.16 (95% CI 0.07 to 0.35). EBM was less likely in infants with dehydration (aOR 0.49 (95% CI 0.33 to 0.71)), chest retractions (aOR 0.69 (95% CI 0.52 to 0.91)) and nasal flaring (aOR 0.69 (95% CI 0.52 to 0.92)). EBM was associated with reduced odds of hospitalisation at the index visit (aOR 0.77 (95% CI 0.60 to 0.98)) but not at revisits (aOR 1.17 (95% CI 0.74 to 1.85)).ConclusionsInfants with bronchiolitis frequently do not receive full-EBM ED management, particularly those outside of the UK/Ireland. Furthermore, there is marked variation in full-EBM between paediatric emergency networks, and full-EBM delivery is associated with lower likelihood of hospitalisation. Given the global bronchiolitis burden, international ED-focused deimplementation of non-indicated interventions to enhance EBM is needed.
- Published
- 2022