Utilization of nebulized 3% saline in infants hospitalized with bronchiolitis

Todd A. Florin*, Terri Byczkowski, Richard M. Ruddy, Joseph J. Zorc, Matthew Test, Samir S. Shah

*Corresponding author for this work

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Objectives To describe utilization of 3% hypertonic saline (HTS) in hospitalized infants and to evaluate the association between HTS use and length of stay (LOS) in a real-world setting. Study design This multicenter retrospective cohort study included infants <12 months hospitalized with bronchiolitis between October 2008 and September 2011 using the Pediatric Health Information System. HTS use was categorized as trial, rescue, daily, or sporadic. Differences in LOS were compared after matching daily HTS recipients and nonrecipients on propensity score. Results There were 63-337 hospitalizations for bronchiolitis. HTS was used in 24 of 42 hospitals and 2.9% of all hospitalizations. HTS use increased from 0.4% of visits in 2008 to 9.2% of visits in 2011. There was substantial variation in HTS use across hospitals (range 0.1%-32.6%). When used, HTS was given daily during 60.6% of hospitalizations, sporadically in 10.4%, as a trial in 11.3%, and as a rescue in 17.7%. The propensity score-matched analysis of daily HTS recipients (n = 953) vs nonrecipients (n = 953) showed no difference in mean LOS (HTS 2.3 days vs nonrecipients 2.5 days; β-coefficient -0.04; 95% CI -0.15, 0.07; P =.5) or odds of staying longer than 1, 2, or 3 days. Daily HTS recipients had a 33% decreased odds of staying in the hospital 4 days compared with nonrecipients (OR 0.67; 95% CI 0.47, 0.97; P =.03). Conclusions Variation in HTS use and the lack of association between HTS and mean LOS demonstrates the need for further research to standardize HTS use and better define the infants for whom HTS will be most beneficial.

Original languageEnglish (US)
Pages (from-to)1168-1174.e2
JournalJournal of Pediatrics
Volume166
Issue number5
DOIs
StatePublished - Jan 1 2015

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Bronchiolitis
Length of Stay
Propensity Score
Hospitalization
Health Information Systems
Cohort Studies
Retrospective Studies
Pediatrics
Research

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Florin, T. A., Byczkowski, T., Ruddy, R. M., Zorc, J. J., Test, M., & Shah, S. S. (2015). Utilization of nebulized 3% saline in infants hospitalized with bronchiolitis. Journal of Pediatrics, 166(5), 1168-1174.e2. https://doi.org/10.1016/j.jpeds.2015.01.045
Florin, Todd A. ; Byczkowski, Terri ; Ruddy, Richard M. ; Zorc, Joseph J. ; Test, Matthew ; Shah, Samir S. / Utilization of nebulized 3% saline in infants hospitalized with bronchiolitis. In: Journal of Pediatrics. 2015 ; Vol. 166, No. 5. pp. 1168-1174.e2.
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title = "Utilization of nebulized 3{\%} saline in infants hospitalized with bronchiolitis",
abstract = "Objectives To describe utilization of 3{\%} hypertonic saline (HTS) in hospitalized infants and to evaluate the association between HTS use and length of stay (LOS) in a real-world setting. Study design This multicenter retrospective cohort study included infants <12 months hospitalized with bronchiolitis between October 2008 and September 2011 using the Pediatric Health Information System. HTS use was categorized as trial, rescue, daily, or sporadic. Differences in LOS were compared after matching daily HTS recipients and nonrecipients on propensity score. Results There were 63-337 hospitalizations for bronchiolitis. HTS was used in 24 of 42 hospitals and 2.9{\%} of all hospitalizations. HTS use increased from 0.4{\%} of visits in 2008 to 9.2{\%} of visits in 2011. There was substantial variation in HTS use across hospitals (range 0.1{\%}-32.6{\%}). When used, HTS was given daily during 60.6{\%} of hospitalizations, sporadically in 10.4{\%}, as a trial in 11.3{\%}, and as a rescue in 17.7{\%}. The propensity score-matched analysis of daily HTS recipients (n = 953) vs nonrecipients (n = 953) showed no difference in mean LOS (HTS 2.3 days vs nonrecipients 2.5 days; β-coefficient -0.04; 95{\%} CI -0.15, 0.07; P =.5) or odds of staying longer than 1, 2, or 3 days. Daily HTS recipients had a 33{\%} decreased odds of staying in the hospital 4 days compared with nonrecipients (OR 0.67; 95{\%} CI 0.47, 0.97; P =.03). Conclusions Variation in HTS use and the lack of association between HTS and mean LOS demonstrates the need for further research to standardize HTS use and better define the infants for whom HTS will be most beneficial.",
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Florin, TA, Byczkowski, T, Ruddy, RM, Zorc, JJ, Test, M & Shah, SS 2015, 'Utilization of nebulized 3% saline in infants hospitalized with bronchiolitis', Journal of Pediatrics, vol. 166, no. 5, pp. 1168-1174.e2. https://doi.org/10.1016/j.jpeds.2015.01.045

Utilization of nebulized 3% saline in infants hospitalized with bronchiolitis. / Florin, Todd A.; Byczkowski, Terri; Ruddy, Richard M.; Zorc, Joseph J.; Test, Matthew; Shah, Samir S.

In: Journal of Pediatrics, Vol. 166, No. 5, 01.01.2015, p. 1168-1174.e2.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Utilization of nebulized 3% saline in infants hospitalized with bronchiolitis

AU - Florin, Todd A.

AU - Byczkowski, Terri

AU - Ruddy, Richard M.

AU - Zorc, Joseph J.

AU - Test, Matthew

AU - Shah, Samir S.

PY - 2015/1/1

Y1 - 2015/1/1

N2 - Objectives To describe utilization of 3% hypertonic saline (HTS) in hospitalized infants and to evaluate the association between HTS use and length of stay (LOS) in a real-world setting. Study design This multicenter retrospective cohort study included infants <12 months hospitalized with bronchiolitis between October 2008 and September 2011 using the Pediatric Health Information System. HTS use was categorized as trial, rescue, daily, or sporadic. Differences in LOS were compared after matching daily HTS recipients and nonrecipients on propensity score. Results There were 63-337 hospitalizations for bronchiolitis. HTS was used in 24 of 42 hospitals and 2.9% of all hospitalizations. HTS use increased from 0.4% of visits in 2008 to 9.2% of visits in 2011. There was substantial variation in HTS use across hospitals (range 0.1%-32.6%). When used, HTS was given daily during 60.6% of hospitalizations, sporadically in 10.4%, as a trial in 11.3%, and as a rescue in 17.7%. The propensity score-matched analysis of daily HTS recipients (n = 953) vs nonrecipients (n = 953) showed no difference in mean LOS (HTS 2.3 days vs nonrecipients 2.5 days; β-coefficient -0.04; 95% CI -0.15, 0.07; P =.5) or odds of staying longer than 1, 2, or 3 days. Daily HTS recipients had a 33% decreased odds of staying in the hospital 4 days compared with nonrecipients (OR 0.67; 95% CI 0.47, 0.97; P =.03). Conclusions Variation in HTS use and the lack of association between HTS and mean LOS demonstrates the need for further research to standardize HTS use and better define the infants for whom HTS will be most beneficial.

AB - Objectives To describe utilization of 3% hypertonic saline (HTS) in hospitalized infants and to evaluate the association between HTS use and length of stay (LOS) in a real-world setting. Study design This multicenter retrospective cohort study included infants <12 months hospitalized with bronchiolitis between October 2008 and September 2011 using the Pediatric Health Information System. HTS use was categorized as trial, rescue, daily, or sporadic. Differences in LOS were compared after matching daily HTS recipients and nonrecipients on propensity score. Results There were 63-337 hospitalizations for bronchiolitis. HTS was used in 24 of 42 hospitals and 2.9% of all hospitalizations. HTS use increased from 0.4% of visits in 2008 to 9.2% of visits in 2011. There was substantial variation in HTS use across hospitals (range 0.1%-32.6%). When used, HTS was given daily during 60.6% of hospitalizations, sporadically in 10.4%, as a trial in 11.3%, and as a rescue in 17.7%. The propensity score-matched analysis of daily HTS recipients (n = 953) vs nonrecipients (n = 953) showed no difference in mean LOS (HTS 2.3 days vs nonrecipients 2.5 days; β-coefficient -0.04; 95% CI -0.15, 0.07; P =.5) or odds of staying longer than 1, 2, or 3 days. Daily HTS recipients had a 33% decreased odds of staying in the hospital 4 days compared with nonrecipients (OR 0.67; 95% CI 0.47, 0.97; P =.03). Conclusions Variation in HTS use and the lack of association between HTS and mean LOS demonstrates the need for further research to standardize HTS use and better define the infants for whom HTS will be most beneficial.

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