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European Journal of Pediatrics

, Volume 171, Issue 7, pp 1109–1119 | Cite as

Management of acute bronchiolitis in emergency wards in Spain: variability and appropriateness analysis (aBREVIADo Project)

  • Carlos Ochoa SangradorEmail author
  • Javier González de Dios
  • Research Group of the aBREVIADo Project (Bronchiolitis—Study of Variability, Adequacy, and Adherence)
Original Article

Abstract

Most patients with acute bronchiolitis have a mild course and only require outpatient care. However, some of them have to go to emergency departments, because they have respiratory distress or feeding problems. There, they frequently receive diagnostic and therapeutic procedures. We want to know the variability and appropriateness of these procedures. A cross-sectional study (October 2007 to March 2008) was carried out on 2,430 diagnosed cases of bronchiolitis in hospital emergency departments, which required no hospitalization. An analysis of the appropriateness of the treatments was made in 2,032 cases gathered in ten departments with at least 100 cases, using as criterion the recommendations of a consensus conference. We estimated the adjusted percentages of each department. Most of the bronchiolitis were mild, in spite that they underwent multiple diagnostic and therapeutic procedures. In the acute phase, different treatments were used: inhaled beta 2 agonists (61.4%), antipyretics (17.1%), oral steroids (11.3%), and nebulized adrenaline (9.3%). In the maintenance phase, the most common treatments were: inhaled beta 2 agonists (50.5%), oral steroids (17%), oral beta 2 agonists (14.9%), and antibiotics (6.1%). The 64% of the treatments used in the acute phase and the 55.9% in the maintenance phase were considered inappropriate in the appropriateness analysis; a great heterogeneity among centers was found. Conclusions: There are discrepancies between clinical practice and evidence-based management of bronchiolitis in Spanish emergency departments. Inappropriate treatments were used in more than half of patients. The wide variation between centers shows the influence of local prescribing habits and reveals the scope for improvement.

Keywords

Viral bronchiolitis/diagnosis Viral bronchiolitis/treatment Infants Emergency hospital service Physician’s practice patterns 

Notes

Conflict of interests

There are no conflicts of interest to report. The authors have not any financial relationship with the foundation that sponsored the research. The related grant only covered literature searches, interlibrary lending costs, digital data handling, and travel expenses of the consensus conference.

Financial source

This project was financed by a grant from the Hospital de Torrevieja Foundation between June 2007 and June 2009 (protocol code: BECA0001).

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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Carlos Ochoa Sangrador
    • 1
    Email author
  • Javier González de Dios
    • 2
  • Research Group of the aBREVIADo Project (Bronchiolitis—Study of Variability, Adequacy, and Adherence)
  1. 1.Pediatric ServiceHospital Virgen de la ConchaZamoraSpain
  2. 2.Department of PediatricsUniversidad Miguel Hernández, Hospital General Universitario de AlicanteAlicanteSpain

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