Daniel R Duncan1, Amanda S Growdon2, Enju Liu3, Kara Larson1, Madeline Gonzalez4, Kerri Norris4, Rachel L Rosen5. 1. Aerodigestive Center, Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, MA. 2. Division of General Pediatrics, Boston Children's Hospital, Boston, MA. 3. Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, MA. 4. Department of Reimbursement and Decision Support, Boston Children's Hospital, Boston, MA. 5. Aerodigestive Center, Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, MA. Electronic address: Rachel.Rosen@childrens.harvard.edu.
Abstract
OBJECTIVES: To determine if hospitalization, testing, diagnosis, and management of suspected gastroesophageal reflux, and follow-up visits decreased since introduction of American Academy of Pediatrics guidelines for brief resolved unexplained events (BRUEs). STUDY DESIGN: We performed a retrospective cohort study of infants with BRUE evaluated at Boston Children's Hospital in the year before and after guideline implementation to determine if practice patterns have changed. Outcomes included hospitalization rates, frequency of swallow assessments, other diagnostic testing, and reflux diagnoses, cost of care, and number of repeat visits. Groups were compared based on whether they presented before or after guideline implementation. RESULTS: In total, 359 subjects (186 pre-, 173 post-guidelines) were identified. There were no significant differences in practice patterns or outcomes before or after guideline implementation. Subjects had mean age 2.53 ± 0.15 months, and 80% were hospitalized for 2.49 ± 0.26 days. Each subject had 2.47 diagnostic tests performed, and 89% were noncontributory. Despite only 13% having videofluoroscopic swallow study performed, 72% showed aspiration/penetration. No subject had gastroesophageal reflux testing, yet reflux was implicated as the cause for admission in 40% of subjects, resulting in increased odds of discharge on acid suppressing medications (OR 2.88, 95% CI 1.68-4.92, P = .0001). In follow-up, 28% of subjects had repeat hospitalizations or emergency department visits for persistent symptoms. CONCLUSIONS: Infants with BRUE continue to undergo low-yield diagnostic testing and after admission remain symptomatic and frequently re-present to medical care. Swallow testing remains infrequent despite its high-yield, reflux continues to be implicated and children are still being discharged on acid suppression despite lack of efficacy.
OBJECTIVES: To determine if hospitalization, testing, diagnosis, and management of suspected gastroesophageal reflux, and follow-up visits decreased since introduction of American Academy of Pediatrics guidelines for brief resolved unexplained events (BRUEs). STUDY DESIGN: We performed a retrospective cohort study of infants with BRUE evaluated at Boston Children's Hospital in the year before and after guideline implementation to determine if practice patterns have changed. Outcomes included hospitalization rates, frequency of swallow assessments, other diagnostic testing, and reflux diagnoses, cost of care, and number of repeat visits. Groups were compared based on whether they presented before or after guideline implementation. RESULTS: In total, 359 subjects (186 pre-, 173 post-guidelines) were identified. There were no significant differences in practice patterns or outcomes before or after guideline implementation. Subjects had mean age 2.53 ± 0.15 months, and 80% were hospitalized for 2.49 ± 0.26 days. Each subject had 2.47 diagnostic tests performed, and 89% were noncontributory. Despite only 13% having videofluoroscopic swallow study performed, 72% showed aspiration/penetration. No subject had gastroesophageal reflux testing, yet reflux was implicated as the cause for admission in 40% of subjects, resulting in increased odds of discharge on acid suppressing medications (OR 2.88, 95% CI 1.68-4.92, P = .0001). In follow-up, 28% of subjects had repeat hospitalizations or emergency department visits for persistent symptoms. CONCLUSIONS:Infants with BRUE continue to undergo low-yield diagnostic testing and after admission remain symptomatic and frequently re-present to medical care. Swallow testing remains infrequent despite its high-yield, reflux continues to be implicated and children are still being discharged on acid suppression despite lack of efficacy.
Authors: Gabrielle Zimbric; Joshua L Bonkowsky; W Daniel Jackson; Christopher G Maloney; Rajendu Srivastava Journal: J Hosp Med Date: 2012-04-24 Impact factor: 2.960
Authors: Melanie Greifer; Maria T Santiago; Kalliope Tsirilakis; Jeffrey C Cheng; Lee P Smith Journal: Int J Pediatr Otorhinolaryngol Date: 2015-03-14 Impact factor: 1.675
Authors: Daniel R Duncan; Kara Larson; Kathryn Davidson; Kara May; Reza Rahbar; Rachel L Rosen Journal: J Pediatr Gastroenterol Nutr Date: 2019-02 Impact factor: 2.839