Emergency Department management of bronchiolitis in the United States

Constance Gong, Terri Byczkowski, Constance McAneney, Monika K. Goyal, Todd A. Florin

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Objective The aim of this study was to examine differences between general and pediatric emergency departments (PEDs) in adherence to the American Academy of Pediatrics bronchiolitis management guidelines. Methods We conducted a nationally representative study of ED visits by infants younger than 24 months with bronchiolitis from 2002 to 2011 using the National Hospital Ambulatory Medical Care Survey. Diagnostic testing (complete blood counts, radiographs) and medication use (albuterol, corticosteroids, antibiotics and intravenous fluids) in general emergency departments (GEDs) were compared with those in PEDs before and after 2006 American Academy of Pediatrics guideline publication. Weighted percentages were compared, and logistic regression evaluated the association between ED type and resource use. Results Of more than 2.5 million ED visits for bronchiolitis from 2002 to 2011, 77.3% occurred in GEDs. General emergency departments were more likely to use radiography (62.7% vs 42.1%; adjusted odds ratio [aOR], 2.4; 95% confidence interval [CI], 1.4-4.1), antibiotics (41.3% vs 18.8%; aOR, 2.8; 95% CI, 1.5-5.2), and corticosteroids (24.3% vs 12.5%; aOR, 2.1; 95% CI, 1.0-4.5) compared with PEDs. Compared with preguideline, after guideline publication PEDs had a greater decrease in radiography use (-19.7%; 95% CI,-39.3% to-0.03%) compared with GEDs (-12.2%; 95% CI,-22.3% to-2.1%), and PEDs showed a significant decline in corticosteroid use (-12.4%; 95% CI,-22.1% to-2.8%), whereas GEDs showed no significant decline (-4.6%; 95% CI,-13.5% to 4.3%). Conclusions The majority of ED visits for bronchiolitis in the United States occurred in GEDs, yet GEDs had increased use of radiography, corticosteroids, and antibiotics and did not show substantial declines with national guideline publication. Given that national guidelines discourage the use of such tests and treatments in the management of bronchiolitis, efforts are required to decrease ED use of these resources in infants with bronchiolitis, particularly in GEDs.

Original languageEnglish (US)
Pages (from-to)323-329
Number of pages7
JournalPediatric emergency care
Volume35
Issue number5
DOIs
StatePublished - May 1 2019

Fingerprint

Bronchiolitis
Hospital Emergency Service
Confidence Intervals
Pediatrics
Guidelines
Adrenal Cortex Hormones
Radiography
Publications
Odds Ratio
Anti-Bacterial Agents
Health Care Surveys
Blood Cell Count
Albuterol

Keywords

  • NHAMCS
  • bronchiolitis
  • clinical practice guideline
  • evidence-based guidelines
  • resource utilization

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Emergency Medicine

Cite this

Gong, Constance ; Byczkowski, Terri ; McAneney, Constance ; Goyal, Monika K. ; Florin, Todd A. / Emergency Department management of bronchiolitis in the United States. In: Pediatric emergency care. 2019 ; Vol. 35, No. 5. pp. 323-329.
@article{c9ddda1537a84ba9b400ea098fe8268a,
title = "Emergency Department management of bronchiolitis in the United States",
abstract = "Objective The aim of this study was to examine differences between general and pediatric emergency departments (PEDs) in adherence to the American Academy of Pediatrics bronchiolitis management guidelines. Methods We conducted a nationally representative study of ED visits by infants younger than 24 months with bronchiolitis from 2002 to 2011 using the National Hospital Ambulatory Medical Care Survey. Diagnostic testing (complete blood counts, radiographs) and medication use (albuterol, corticosteroids, antibiotics and intravenous fluids) in general emergency departments (GEDs) were compared with those in PEDs before and after 2006 American Academy of Pediatrics guideline publication. Weighted percentages were compared, and logistic regression evaluated the association between ED type and resource use. Results Of more than 2.5 million ED visits for bronchiolitis from 2002 to 2011, 77.3{\%} occurred in GEDs. General emergency departments were more likely to use radiography (62.7{\%} vs 42.1{\%}; adjusted odds ratio [aOR], 2.4; 95{\%} confidence interval [CI], 1.4-4.1), antibiotics (41.3{\%} vs 18.8{\%}; aOR, 2.8; 95{\%} CI, 1.5-5.2), and corticosteroids (24.3{\%} vs 12.5{\%}; aOR, 2.1; 95{\%} CI, 1.0-4.5) compared with PEDs. Compared with preguideline, after guideline publication PEDs had a greater decrease in radiography use (-19.7{\%}; 95{\%} CI,-39.3{\%} to-0.03{\%}) compared with GEDs (-12.2{\%}; 95{\%} CI,-22.3{\%} to-2.1{\%}), and PEDs showed a significant decline in corticosteroid use (-12.4{\%}; 95{\%} CI,-22.1{\%} to-2.8{\%}), whereas GEDs showed no significant decline (-4.6{\%}; 95{\%} CI,-13.5{\%} to 4.3{\%}). Conclusions The majority of ED visits for bronchiolitis in the United States occurred in GEDs, yet GEDs had increased use of radiography, corticosteroids, and antibiotics and did not show substantial declines with national guideline publication. Given that national guidelines discourage the use of such tests and treatments in the management of bronchiolitis, efforts are required to decrease ED use of these resources in infants with bronchiolitis, particularly in GEDs.",
keywords = "NHAMCS, bronchiolitis, clinical practice guideline, evidence-based guidelines, resource utilization",
author = "Constance Gong and Terri Byczkowski and Constance McAneney and Goyal, {Monika K.} and Florin, {Todd A.}",
year = "2019",
month = "5",
day = "1",
doi = "10.1097/PEC.0000000000001145",
language = "English (US)",
volume = "35",
pages = "323--329",
journal = "Pediatric Emergency Care",
issn = "0749-5161",
publisher = "Lippincott Williams and Wilkins",
number = "5",

}

Emergency Department management of bronchiolitis in the United States. / Gong, Constance; Byczkowski, Terri; McAneney, Constance; Goyal, Monika K.; Florin, Todd A.

In: Pediatric emergency care, Vol. 35, No. 5, 01.05.2019, p. 323-329.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Emergency Department management of bronchiolitis in the United States

AU - Gong, Constance

AU - Byczkowski, Terri

AU - McAneney, Constance

AU - Goyal, Monika K.

AU - Florin, Todd A.

PY - 2019/5/1

Y1 - 2019/5/1

N2 - Objective The aim of this study was to examine differences between general and pediatric emergency departments (PEDs) in adherence to the American Academy of Pediatrics bronchiolitis management guidelines. Methods We conducted a nationally representative study of ED visits by infants younger than 24 months with bronchiolitis from 2002 to 2011 using the National Hospital Ambulatory Medical Care Survey. Diagnostic testing (complete blood counts, radiographs) and medication use (albuterol, corticosteroids, antibiotics and intravenous fluids) in general emergency departments (GEDs) were compared with those in PEDs before and after 2006 American Academy of Pediatrics guideline publication. Weighted percentages were compared, and logistic regression evaluated the association between ED type and resource use. Results Of more than 2.5 million ED visits for bronchiolitis from 2002 to 2011, 77.3% occurred in GEDs. General emergency departments were more likely to use radiography (62.7% vs 42.1%; adjusted odds ratio [aOR], 2.4; 95% confidence interval [CI], 1.4-4.1), antibiotics (41.3% vs 18.8%; aOR, 2.8; 95% CI, 1.5-5.2), and corticosteroids (24.3% vs 12.5%; aOR, 2.1; 95% CI, 1.0-4.5) compared with PEDs. Compared with preguideline, after guideline publication PEDs had a greater decrease in radiography use (-19.7%; 95% CI,-39.3% to-0.03%) compared with GEDs (-12.2%; 95% CI,-22.3% to-2.1%), and PEDs showed a significant decline in corticosteroid use (-12.4%; 95% CI,-22.1% to-2.8%), whereas GEDs showed no significant decline (-4.6%; 95% CI,-13.5% to 4.3%). Conclusions The majority of ED visits for bronchiolitis in the United States occurred in GEDs, yet GEDs had increased use of radiography, corticosteroids, and antibiotics and did not show substantial declines with national guideline publication. Given that national guidelines discourage the use of such tests and treatments in the management of bronchiolitis, efforts are required to decrease ED use of these resources in infants with bronchiolitis, particularly in GEDs.

AB - Objective The aim of this study was to examine differences between general and pediatric emergency departments (PEDs) in adherence to the American Academy of Pediatrics bronchiolitis management guidelines. Methods We conducted a nationally representative study of ED visits by infants younger than 24 months with bronchiolitis from 2002 to 2011 using the National Hospital Ambulatory Medical Care Survey. Diagnostic testing (complete blood counts, radiographs) and medication use (albuterol, corticosteroids, antibiotics and intravenous fluids) in general emergency departments (GEDs) were compared with those in PEDs before and after 2006 American Academy of Pediatrics guideline publication. Weighted percentages were compared, and logistic regression evaluated the association between ED type and resource use. Results Of more than 2.5 million ED visits for bronchiolitis from 2002 to 2011, 77.3% occurred in GEDs. General emergency departments were more likely to use radiography (62.7% vs 42.1%; adjusted odds ratio [aOR], 2.4; 95% confidence interval [CI], 1.4-4.1), antibiotics (41.3% vs 18.8%; aOR, 2.8; 95% CI, 1.5-5.2), and corticosteroids (24.3% vs 12.5%; aOR, 2.1; 95% CI, 1.0-4.5) compared with PEDs. Compared with preguideline, after guideline publication PEDs had a greater decrease in radiography use (-19.7%; 95% CI,-39.3% to-0.03%) compared with GEDs (-12.2%; 95% CI,-22.3% to-2.1%), and PEDs showed a significant decline in corticosteroid use (-12.4%; 95% CI,-22.1% to-2.8%), whereas GEDs showed no significant decline (-4.6%; 95% CI,-13.5% to 4.3%). Conclusions The majority of ED visits for bronchiolitis in the United States occurred in GEDs, yet GEDs had increased use of radiography, corticosteroids, and antibiotics and did not show substantial declines with national guideline publication. Given that national guidelines discourage the use of such tests and treatments in the management of bronchiolitis, efforts are required to decrease ED use of these resources in infants with bronchiolitis, particularly in GEDs.

KW - NHAMCS

KW - bronchiolitis

KW - clinical practice guideline

KW - evidence-based guidelines

KW - resource utilization

UR - http://www.scopus.com/inward/record.url?scp=85018678170&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85018678170&partnerID=8YFLogxK

U2 - 10.1097/PEC.0000000000001145

DO - 10.1097/PEC.0000000000001145

M3 - Article

VL - 35

SP - 323

EP - 329

JO - Pediatric Emergency Care

JF - Pediatric Emergency Care

SN - 0749-5161

IS - 5

ER -