OBJECTIVE: Recent practice guidelines from the American Academy of Pediatrics recommend limiting use of bronchodilators, corticosteroids, antibiotics, and diagnostic testing for patients with bronchiolitis. We sought to determine the association of the evidence-based guidelines with bronchiolitis care in the emergency department (ED). METHODS:We analyzed data from the National Hospital Ambulatory Medical Care Survey, a nationally representative sample of ED visits. We compared utilization for patient visits before and after the publication of the guidelines. We used logistic regression to determine the association of the availability of the guidelines with resource utilization.RESULTS: Bronchodilators were used in 53.8% of patient visits with no differences noted after the introduction of the guidelines (53.6% vs 54.2%, P = .91). Systemic steroids were used in 20.4% of patient visits, and antibiotics were given in 33.2% of visits. There were no changes in the frequency of corticosteroid (21.9% vs 17.8%, P = .31) or antibiotic (33.6% vs 29.7%, P = .51) use. There was an associated decrease in use of chest x-rays (65.3% vs 48.6%, P = .005). This association remained significant after adjusting for patient and hospital characteristics with an adjusted odds ratio of 0.41 (95% confidence interval 0.26-0.67).CONCLUSIONS: For patients seen in the ED with bronchiolitis, utilization of diagnostic imaging has decreased with the availability of the American Academy of Pediatrics practice guidelines. However, there has not been an associated decrease in use of nonrecommended therapies. Targeted efforts will likely be required to change practice significantly.

A new endoconidial taxon, Endophoma elongata gen. et sp. nov., isolated from bat-cave soil, is reported from Alberta, Canada. It is morphologically unique in producing two forms of unilocular, endoconidial conidiomata (i.e. a superficially Phoma-like spherical, often ostiolate form and a cylindrical, non-ostiolate, often setose cleistopycnidial form). Locules of both forms are pseudoparenchymatous, filled with hyaline, thin-walled, endoconidial conidiogenous cells. Endoconidia are hyaline and unicellular. One- or two-celled chlamydospores are abundant in culture. Phylogenetic analysis of the LSU, ITS and β-tubulin regions indicates Endophoma is a member of the Didymellaceae and remote from all other endoconidial genera. Endoconidiogenesis has not been reported previously within the Didymellaceae, and Endophoma represents the first report of a coelomycetous, endoconidial genus in the Pleosporales.

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