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

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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.

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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).

Author information

Authors and Affiliations

  1. Pediatric Service, Hospital Virgen de la Concha, C/Jardines Eduardo Barrón 1 bis 3°, 49018, Zamora, Spain

    Carlos Ochoa Sangrador

  2. Department of Pediatrics, Universidad Miguel Hernández, Hospital General Universitario de Alicante, Alicante, Spain

    Javier González de Dios

Authors
  1. Carlos Ochoa Sangrador
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  2. Javier González de Dios
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Consortia

Research Group of the aBREVIADo Project (Bronchiolitis—Study of Variability, Adequacy, and Adherence)

Corresponding author

Correspondence to Carlos Ochoa Sangrador.

Additional information

Members of the Research Group are specified in Appendix 1.

Appendix 1

Appendix 1

Members of the research group

ANDALUCÍA:

Hospital de Torrecárdenas. Almería (MD. Gámez Gómez, J. Batlles Garrido, J.E. Cabrera Servilla, I. García Escobar, F. Giménez Sánchez, L. Ruiz Tudela), C.Salud Candelaria. Sevilla (A. Fernández Valverde, M,G. Bueno Rodríguez, I. Ramón Faba, M. Praena Crespo)

ARAGÓN:

C.Salud Fuentes del Ebro. Zaragoza (J.A. Castillo Laita, R. Macipe Costa), Hospital Infantil Universitario Miguel Servet. Zaragoza (C. Campos Calleja, M.C. García Jiménez, R. Pérez Delgado, Y. Romero Salas)

ASTURIAS:

C.Salud Contrueces (M. López Benito), C.Salud El Llano (V. Martínez Suárez, M. García Balbuena), C.Salud Infesto (I. Mora Gandarillas), C.Salud La Magdalena (J.I. Pérez Candás), C.S. La Felguera (M. Fernández Pérez, C. Gonzavo Rodríguez), C.Salud Laviada (A. Cobo Ruisánchez, B. Yáñez Meana), C.Salud Natahoyo (A. Hernandez Encinas), C.Salud Otero (B. Domínguez Aurrecoechea), C.Salud Pravia (M. García Adaro, R. Buznego Sánchez), C.Salud Tineo (M. Fernández Francés), C.Salud Puerta La Villa (I. Franco, S. Ballesteros), C.Salud Sama (M. Benito Martín, A.J. Mira López, M. Fernández López), Hospital Cabueñes. Gijón (C. Molinos Norniella, C. Pérez Méndez, E. Fernández Fernández, J. Fernández Antuña), Hospital Central de Asturias. Oviedo (J. Rodríguez Suárez, S. Jiménez Treviño, F. Álvarez Caro)

CANARIAS:

Hospital Universitario Materno Infantil. Las Palmas de Gran Canarias (S. Todorcevic, M.R. García Luzardo)

CANTABRIA:

C.Salud Buelna (A. Bercedo Sanz), Hospital Marqués de Valdecilla. Santander (M. J. Cabero Pérez, L. Álvarez Granda, E. Pérez Belmonte)

CASTILLA Y LEÓN:

Hospital Complejo Asistencial de León. León (S. Lapeña López de Armentia, R. Morales Sánchez, L. Fernández Pérez), C.Salud Jardinillos. Palencia (S. Alberola López, I. Pérez García), C.Salud Pintor Oliva. Palencia (A.B. Camina Gutiérrez, J. G. Santos García), C.Salud Venta de Baños. Palencia (I. Casares Alonso), C.Salud Villamuriel. Palencia (A. Cano Garcinuño), Hospital Río Carrión. Palencia (C. Urueña Leal, J.M. Andrés de Llano, J.E. Fernández Alonso, J.M. Bartolomé Porro), C.Salud Ciudad Rodrigo. Salamanca (M.C. Sánchez Jiménez, M.J. Estévez Amores), C.Salud Ledesma. Salamanca (M. Mendoza Sánchez), C.Salud Miguel Armijo. Salamanca (J. López Ávila), C.Salud San Bernardo. Salamanca (A. Martín Ruano), C.Salud Santa Marta. Salamanca (J. Martín Ruano, B. de Dios Martín,), Hospital Complejo Hospitalario de Salamanca. Salamanca (S. Fernández de Miguel, J.M. Sánchez Granados, O. Serrano Ayestaran), Hospital Clínico Universitario. Valladolid (F. Conde Redondo, A. del Río López, V. Matías del Pozo), Hospital Río Hortega. Valladolid (F. Centeno Malfaz, C. Alcalde Martín, B. Bello Martínez, L. Crespo Valderrábano, C. Gutiérrez Abad), C.Salud Benavente Sur. Zamora (M.E. Vázquez Fernández), C.Salud Parada de Molino. Zamora (A. Cortés Gabaudán), C.Salud Puerta Nueva. Zamora (M.M. Miguélez Vara, P. Pérez García), C.Salud Santa Elena. Zamora (S. García Vicente), C.Salud Virgen de la Concha. Zamora (M. A. Prieto Figuero, M.J. Piorno Hernández, Mª Jesús Moro Pérez), Hospital Virgen de la Concha. Zamora (C. Ochoa Sangrador, A.F. Bajo Delgado, A. Fernández Testa), Hospital General de Segovia. Segovia (C. Ortega Casanueva)

CATALUÑA:

ABS Llefiá. Badalona. Barcelona (G. Ruiz Aragón), ABS-7 La Salut. Barcelona (P. Aizpurua Galdeano), Hospital Sant Joan de Deu. Barcelona (G. Claret Teruel, S. Fernández Ureña), Hospital Universitari Germans Trias i Pujol. Badalona. Barcelona (M. Méndez Hernández, F. Brossa Guerra, J. Fàbrega Sabaté)- ABS Girona-3. Gerona (R.B. Cortés Marina, E. Fortea Gimeno), ABS Girona-4. Gerona (J.C. Buñuel Alvarez, C. Vila Pablos), Hospital Josep Trueta. Gerona (S. Uriel Prat, Ll. Mayol i Canals)

COMUNIDAD VALENCIANA:

C.Salud Acequión. Alicante (C. Buhedo Gordillo, G. Rinero de Campos), C.Salud El Cabo. Alicante (M.J. Mateo Moraleda, T. Pérez Martín, A. Redondo, A.Sanguino, B. Sepulcre, B. Serra, A. Tosao), C.Salud El Campello. Alicante (J. Galiano Olivares), C.Salud Guardamar del Segura. Alicante (C.P. Rico Uriós), C.Salud Hospital Provincial. Alicante (M.C. Sirvent Mayor, M.J. Fernández Tarí), C.Salud La Mata. Alicante (M.S. Fuggini), C.Saud Mutxamel. Alicante (L. Comino Almenara, E. Gutiérrez Roble, A. Melnikova, M. Riva), C.Salud Rojales i Benijofar. Alicante (A. Bernabé Gutiérrez, I. Degtyareva), Hospital de Orihuela. Alicante (V. Cañadas Olmo, F. Goberna Burguera), Hospital de San Juan. Alicante (J.L. Mestre Ricote), Hospital de Torrevieja. Alicante (J. González de Dios, C. Rivas Juesas), C.Salud Gran Vía. Castellón (E. Fabregat Ferrer, M.J. Palomares Gimeno), Hospital de La Plana. Villarreal. Castellón (J. Colomer Pellicer), C.Salud La Eliana. Valencia (I. Úbeda Sansano, M. Romero García), C.Salud de Meliana. Valencia (A. Plaza Miranda), Consultorio Auxiliar Albalat de la Ribera. Valencia (C. Sánchez Medina), Consultorio Auxiliar Barrio de la Luz. Valencia (T. Álvarez de Laviada Mulero), C.Salud Padre Jofré. Valencia (P. Barona Zamora), C.Salud Serrería I. Valencia (M. Asensi Monzó)

EXTREMADURA:

C.Salud Talavera la Real. Badajoz (C.M. Gómez Málaga), C.Salud Urbano-I. Badajoz (J.J. Cuervo Valdés), C.Salud Villanueva de la Serena Sur. Badajoz (D. Barroso Espadero)

GALICIA:

C.Salud Santa Comba. La Coruña (M.E. Amigo Ferreiro), Hospital Arquitecto Marcide. Ferrol. La Coruña (E. García Fernández, A.I. García Villar, R.M. Romaris Barca, M. Santos Tapia), Hospital Clínico de Santiago. Santiago de Compostela. La Coruña (A. Miras Veiga, F. Martinón Torres, N. Martinón Torres, L. Redondo Collazo), Hospital Virxe da Xunqueira. Cee. La Coruña (M.I. Quintela Fernández), Hospital Monforte. Monforte de Lemos. Lugo (S.A. Fernández Cebrián, M.J. Pita Pérez, F. J. Vadillo González), Hospital da Costa. Burela. Lugo (A.G. Andrés Andrés, P. Lago Manchado), Hospital Complejo Hospitalario de Ourense. Orense (C. Lorenzo Legerén, M. Berrocal Castañeda, J.M. Iglesias Meleiro), Complejo Hospitalario Universitario de Vigo. Pontevedra (E. González Colmenero, J. Antelo Cortizas, E. García Martínez, A. Ruiz Conde)

MADRID:

C.Salud Barrio del Pilar (P. González Rodríguez), C.Salud Canillejas (O. Cortés Rico), C.Salud Entrevías-Área 1 (M. Aparicio Rodrigo), C.Salud General Ricardos (G. Orejón de Luna, M.M. Martín Mate), C.Salud Guayaba (M. Duelo Marcos, C. Indaberea Iguaran, A. Nuñez Giralda, F. Muñoz Velasco), C.Salud Juncal (L. Perdikidis Oliveri), C.Salud Mar Báltico-Área 4 (J.L. Montón Álvarez, V. Orbe León), C.Salud Potes. Área 11 (M. Fernández Rodríguez), Hospital Gregorio Marañón (M.M. Guerrero, R. Marañón Pardillo, A. Peñalba Cítores)

PÁIS VASCO:

C.Salud Bidebieta. Guipúzcoa (M. Callén Blecua), Hospital de Donosita. San Sebastián. Guipúzcoa (J. Korta Murua, F.J. Mintegui Aramburu, I. Olaciregui Echenique, E. Rezola Arcelus), Hospital de Basurto. Vizcaya (C. González Díaz), Hospital de Cruces. Baracaldo. Vizcaya (J. Sánchez Echaniz)

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Ochoa Sangrador, C., González de Dios, J. & Research Group of the aBREVIADo Project (Bronchiolitis—Study of Variability, Adequacy, and Adherence). Management of acute bronchiolitis in emergency wards in Spain: variability and appropriateness analysis (aBREVIADo Project). Eur J Pediatr 171, 1109–1119 (2012). https://doi.org/10.1007/s00431-012-1683-y

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