Practice variation in acute bronchiolitis: A pediatric emergency research networks study

The Pediatric Emergency Research Networks (PERN)

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

BACKGROUND AND OBJECTIVES: Studies characterizing hospitalizations in bronchiolitis did not identify patients receiving evidence-based supportive therapies (EBSTs). We aimed to evaluate intersite and internetwork variation in receipt of ≥1 EBSTs during the hospital management of infants diagnosed with bronchiolitis in 38 emergency departments of pediatric emergency research networks in Canada, the United States, Australia, New Zealand, the United Kingdom, Ireland, Spain, and Portugal. We hypothesized that there would be significant variation, adjusted for patient characteristics. METHODS: Retrospective cohort study of previously healthy infants aged <12 months with bronchiolitis. Our primary outcome was that hospitalization occurred with EBST (ie, parenteral fluids, oxygen, or airway support). RESULTS: Out of 3725 participants, 1466 (39%) were hospitalized, and 1023 out of 1466 participants (69.8%) received EBST. The use of EBST varied by site (P < .001; range 6%-99%, median 23%), but not by network (P = .2). Significant multivariable predictors and their odds ratios (ORs) were as follows: age (0.9), oxygen saturation (1.3), apnea (3.4), dehydration (3.2), nasal flaring and/or grunting (2.4), poor feeding (2.1), chest retractions (1.9), and respiratory rate (1.2). The use of pharmacotherapy and radiography varied by network and site (P < .001), with respective intersite ranges 2% to 79% and 1.6% to 81%. Compared with Australia and New Zealand, the multivariable OR for the use of pharmacotherapy in Spain and Portugal was 22.7 (95% confidence interval [CI]: 4.5-111), use in Canada was 11.5 (95% CI: 3.7-36), use in the United States was 6.8 (95% CI: 2.3-19.8), and use in the United Kingdom was 1.4 (95% CI: 0.4-4.2). Compared with United Kingdom, OR for radiography use in the United States was 4.9 (95% CI 2.0-12.2), use in Canada was 4.9 (95% CI 1.9-12.6), use in Spain and Portugal was 2.4 (95% CI 0.6-9.8), and use in Australia and New Zealand was 1.8 (95% CI 0.7-4.7). CONCLUSIONS: More than 30% of infants hospitalized with bronchiolitis received no EBST. The hospital site was a source of variation in all study outcomes, and the network also predicted the use of pharmacotherapy and radiography.

Original languageEnglish (US)
JournalPediatrics
Volume140
Issue number6
DOIs
StatePublished - Dec 1 2017

Fingerprint

Bronchiolitis
Emergencies
Confidence Intervals
Pediatrics
Research
Portugal
New Zealand
Radiography
Spain
Canada
Odds Ratio
Drug Therapy
Hospitalization
Therapeutics
Oxygen
Apnea
Respiratory Rate
Dehydration
Ireland
Nose

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

The Pediatric Emergency Research Networks (PERN). / Practice variation in acute bronchiolitis : A pediatric emergency research networks study. In: Pediatrics. 2017 ; Vol. 140, No. 6.
@article{b486973e3bc24a89899000514f6dfc40,
title = "Practice variation in acute bronchiolitis: A pediatric emergency research networks study",
abstract = "BACKGROUND AND OBJECTIVES: Studies characterizing hospitalizations in bronchiolitis did not identify patients receiving evidence-based supportive therapies (EBSTs). We aimed to evaluate intersite and internetwork variation in receipt of ≥1 EBSTs during the hospital management of infants diagnosed with bronchiolitis in 38 emergency departments of pediatric emergency research networks in Canada, the United States, Australia, New Zealand, the United Kingdom, Ireland, Spain, and Portugal. We hypothesized that there would be significant variation, adjusted for patient characteristics. METHODS: Retrospective cohort study of previously healthy infants aged <12 months with bronchiolitis. Our primary outcome was that hospitalization occurred with EBST (ie, parenteral fluids, oxygen, or airway support). RESULTS: Out of 3725 participants, 1466 (39{\%}) were hospitalized, and 1023 out of 1466 participants (69.8{\%}) received EBST. The use of EBST varied by site (P < .001; range 6{\%}-99{\%}, median 23{\%}), but not by network (P = .2). Significant multivariable predictors and their odds ratios (ORs) were as follows: age (0.9), oxygen saturation (1.3), apnea (3.4), dehydration (3.2), nasal flaring and/or grunting (2.4), poor feeding (2.1), chest retractions (1.9), and respiratory rate (1.2). The use of pharmacotherapy and radiography varied by network and site (P < .001), with respective intersite ranges 2{\%} to 79{\%} and 1.6{\%} to 81{\%}. Compared with Australia and New Zealand, the multivariable OR for the use of pharmacotherapy in Spain and Portugal was 22.7 (95{\%} confidence interval [CI]: 4.5-111), use in Canada was 11.5 (95{\%} CI: 3.7-36), use in the United States was 6.8 (95{\%} CI: 2.3-19.8), and use in the United Kingdom was 1.4 (95{\%} CI: 0.4-4.2). Compared with United Kingdom, OR for radiography use in the United States was 4.9 (95{\%} CI 2.0-12.2), use in Canada was 4.9 (95{\%} CI 1.9-12.6), use in Spain and Portugal was 2.4 (95{\%} CI 0.6-9.8), and use in Australia and New Zealand was 1.8 (95{\%} CI 0.7-4.7). CONCLUSIONS: More than 30{\%} of infants hospitalized with bronchiolitis received no EBST. The hospital site was a source of variation in all study outcomes, and the network also predicted the use of pharmacotherapy and radiography.",
author = "{The Pediatric Emergency Research Networks (PERN)} and Suzanne Schuh and Babl, {Franz E.} and Dalziel, {Stuart R.} and Freedman, {Stephen B.} and Macias, {Charles G.} and Derek Stephens and Steele, {Dale W.} and Fernandes, {Ricardo M.} and Roger Zemek and Plint, {Amy C.} and Florin, {Todd A.} and Lyttle, {Mark D.} and Johnson, {David W.} and Serge Gouin and David Schnadower and Klassen, {Terry P.} and Lalit Bajaj and Javier Benito and Anupam Kharbanda and Nathan Kuppermann and James Chamberlain and Santiago Mintegi and Rakesh Mistry and Lise Nigrovic and Damien Roland and {Van De Voorde}, Patrick",
year = "2017",
month = "12",
day = "1",
doi = "10.1542/peds.2017-0842",
language = "English (US)",
volume = "140",
journal = "Pediatrics",
issn = "0031-4005",
publisher = "American Academy of Pediatrics",
number = "6",

}

Practice variation in acute bronchiolitis : A pediatric emergency research networks study. / The Pediatric Emergency Research Networks (PERN).

In: Pediatrics, Vol. 140, No. 6, 01.12.2017.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Practice variation in acute bronchiolitis

T2 - A pediatric emergency research networks study

AU - The Pediatric Emergency Research Networks (PERN)

AU - Schuh, Suzanne

AU - Babl, Franz E.

AU - Dalziel, Stuart R.

AU - Freedman, Stephen B.

AU - Macias, Charles G.

AU - Stephens, Derek

AU - Steele, Dale W.

AU - Fernandes, Ricardo M.

AU - Zemek, Roger

AU - Plint, Amy C.

AU - Florin, Todd A.

AU - Lyttle, Mark D.

AU - Johnson, David W.

AU - Gouin, Serge

AU - Schnadower, David

AU - Klassen, Terry P.

AU - Bajaj, Lalit

AU - Benito, Javier

AU - Kharbanda, Anupam

AU - Kuppermann, Nathan

AU - Chamberlain, James

AU - Mintegi, Santiago

AU - Mistry, Rakesh

AU - Nigrovic, Lise

AU - Roland, Damien

AU - Van De Voorde, Patrick

PY - 2017/12/1

Y1 - 2017/12/1

N2 - BACKGROUND AND OBJECTIVES: Studies characterizing hospitalizations in bronchiolitis did not identify patients receiving evidence-based supportive therapies (EBSTs). We aimed to evaluate intersite and internetwork variation in receipt of ≥1 EBSTs during the hospital management of infants diagnosed with bronchiolitis in 38 emergency departments of pediatric emergency research networks in Canada, the United States, Australia, New Zealand, the United Kingdom, Ireland, Spain, and Portugal. We hypothesized that there would be significant variation, adjusted for patient characteristics. METHODS: Retrospective cohort study of previously healthy infants aged <12 months with bronchiolitis. Our primary outcome was that hospitalization occurred with EBST (ie, parenteral fluids, oxygen, or airway support). RESULTS: Out of 3725 participants, 1466 (39%) were hospitalized, and 1023 out of 1466 participants (69.8%) received EBST. The use of EBST varied by site (P < .001; range 6%-99%, median 23%), but not by network (P = .2). Significant multivariable predictors and their odds ratios (ORs) were as follows: age (0.9), oxygen saturation (1.3), apnea (3.4), dehydration (3.2), nasal flaring and/or grunting (2.4), poor feeding (2.1), chest retractions (1.9), and respiratory rate (1.2). The use of pharmacotherapy and radiography varied by network and site (P < .001), with respective intersite ranges 2% to 79% and 1.6% to 81%. Compared with Australia and New Zealand, the multivariable OR for the use of pharmacotherapy in Spain and Portugal was 22.7 (95% confidence interval [CI]: 4.5-111), use in Canada was 11.5 (95% CI: 3.7-36), use in the United States was 6.8 (95% CI: 2.3-19.8), and use in the United Kingdom was 1.4 (95% CI: 0.4-4.2). Compared with United Kingdom, OR for radiography use in the United States was 4.9 (95% CI 2.0-12.2), use in Canada was 4.9 (95% CI 1.9-12.6), use in Spain and Portugal was 2.4 (95% CI 0.6-9.8), and use in Australia and New Zealand was 1.8 (95% CI 0.7-4.7). CONCLUSIONS: More than 30% of infants hospitalized with bronchiolitis received no EBST. The hospital site was a source of variation in all study outcomes, and the network also predicted the use of pharmacotherapy and radiography.

AB - BACKGROUND AND OBJECTIVES: Studies characterizing hospitalizations in bronchiolitis did not identify patients receiving evidence-based supportive therapies (EBSTs). We aimed to evaluate intersite and internetwork variation in receipt of ≥1 EBSTs during the hospital management of infants diagnosed with bronchiolitis in 38 emergency departments of pediatric emergency research networks in Canada, the United States, Australia, New Zealand, the United Kingdom, Ireland, Spain, and Portugal. We hypothesized that there would be significant variation, adjusted for patient characteristics. METHODS: Retrospective cohort study of previously healthy infants aged <12 months with bronchiolitis. Our primary outcome was that hospitalization occurred with EBST (ie, parenteral fluids, oxygen, or airway support). RESULTS: Out of 3725 participants, 1466 (39%) were hospitalized, and 1023 out of 1466 participants (69.8%) received EBST. The use of EBST varied by site (P < .001; range 6%-99%, median 23%), but not by network (P = .2). Significant multivariable predictors and their odds ratios (ORs) were as follows: age (0.9), oxygen saturation (1.3), apnea (3.4), dehydration (3.2), nasal flaring and/or grunting (2.4), poor feeding (2.1), chest retractions (1.9), and respiratory rate (1.2). The use of pharmacotherapy and radiography varied by network and site (P < .001), with respective intersite ranges 2% to 79% and 1.6% to 81%. Compared with Australia and New Zealand, the multivariable OR for the use of pharmacotherapy in Spain and Portugal was 22.7 (95% confidence interval [CI]: 4.5-111), use in Canada was 11.5 (95% CI: 3.7-36), use in the United States was 6.8 (95% CI: 2.3-19.8), and use in the United Kingdom was 1.4 (95% CI: 0.4-4.2). Compared with United Kingdom, OR for radiography use in the United States was 4.9 (95% CI 2.0-12.2), use in Canada was 4.9 (95% CI 1.9-12.6), use in Spain and Portugal was 2.4 (95% CI 0.6-9.8), and use in Australia and New Zealand was 1.8 (95% CI 0.7-4.7). CONCLUSIONS: More than 30% of infants hospitalized with bronchiolitis received no EBST. The hospital site was a source of variation in all study outcomes, and the network also predicted the use of pharmacotherapy and radiography.

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