Christine Andrews1, Sarah L Maxwell2, Ellen Kerns3, Russell McCulloh3, Brian Alverson4. 1. Hasbro Children's Hospital and Alpert Medical School, Brown University, Providence, Rhode Island; christinebandrews@gmail.com. 2. Department of Pediatrics, University of California, San Francisco and UCSF Benioff Children's Hospital, San Francisco, California; and. 3. Children's Hospital and Medical Center Omaha and University of Nebraska Medical Center, Omaha, Nebraska. 4. Hasbro Children's Hospital and Alpert Medical School, Brown University, Providence, Rhode Island.
Abstract
OBJECTIVES: Examine the degree of seasonal variation in nonrecommended resource use for bronchiolitis management subsequent to publication of the American Academy of Pediatrics (AAP) 2014 guidelines. METHODS: We performed a multicenter retrospective cohort study using the Pediatric Health Information System database, examining patients aged 1 to 24 months, diagnosed with bronchiolitis between November 2015 and November 2018. Exclusions included presence of a complex chronic condition, admission to the PICU, hospital stay >10 days, or readmission. Primary outcomes were use rates of viral testing, complete blood count, blood culture, chest radiography, antibiotics, albuterol, and systemic steroids. Each hospital's monthly bronchiolitis census was aggregated into hospital bronchiolitis census quartiles. Mixed-effect logistic regression was performed, comparing the primary outcomes between bronchiolitis census quartiles, adjusting for patient age, race, insurance, hospitalization status, bacterial coinfection, time since publication of latest AAP bronchiolitis guidelines, and clustering by site. RESULTS: In total, 196 902 bronchiolitis patient encounters across 50 US hospitals were analyzed. All hospitals followed a similar census pattern, with peaks during winter months and nadirs during summer months. Chest radiography, albuterol, and systemic steroid use were found to significantly increase in lower bronchiolitis census quartiles, whereas rates of viral testing significantly decreased. No significant variation was found for complete blood count testing, blood culture testing, or antibiotic use. Overall adherence with AAP guidelines increased over time. CONCLUSIONS: Resource use for patients with bronchiolitis varied significantly across hospital bronchiolitis census quartiles despite adjusting for potential known confounders. There remains a need for greater standardization of bronchiolitis management.
OBJECTIVES: Examine the degree of seasonal variation in nonrecommended resource use for bronchiolitis management subsequent to publication of the American Academy of Pediatrics (AAP) 2014 guidelines. METHODS: We performed a multicenter retrospective cohort study using the Pediatric Health Information System database, examining patients aged 1 to 24 months, diagnosed with bronchiolitis between November 2015 and November 2018. Exclusions included presence of a complex chronic condition, admission to the PICU, hospital stay >10 days, or readmission. Primary outcomes were use rates of viral testing, complete blood count, blood culture, chest radiography, antibiotics, albuterol, and systemic steroids. Each hospital's monthly bronchiolitis census was aggregated into hospital bronchiolitis census quartiles. Mixed-effect logistic regression was performed, comparing the primary outcomes between bronchiolitis census quartiles, adjusting for patient age, race, insurance, hospitalization status, bacterial coinfection, time since publication of latest AAPbronchiolitis guidelines, and clustering by site. RESULTS: In total, 196 902 bronchiolitispatient encounters across 50 US hospitals were analyzed. All hospitals followed a similar census pattern, with peaks during winter months and nadirs during summer months. Chest radiography, albuterol, and systemic steroid use were found to significantly increase in lower bronchiolitis census quartiles, whereas rates of viral testing significantly decreased. No significant variation was found for complete blood count testing, blood culture testing, or antibiotic use. Overall adherence with AAP guidelines increased over time. CONCLUSIONS: Resource use for patients with bronchiolitis varied significantly across hospital bronchiolitis census quartiles despite adjusting for potential known confounders. There remains a need for greater standardization of bronchiolitis management.
Authors: Todd A Florin; Terri Byczkowski; Richard M Ruddy; Joseph J Zorc; Matthew Test; Samir S Shah Journal: J Pediatr Date: 2014-07-09 Impact factor: 4.406
Authors: Aubree C Honcoop; Patricia Poitevien; Ellen Kerns; Brian Alverson; Russell J McCulloh Journal: Acad Emerg Med Date: 2021-06-11 Impact factor: 5.221