Change in viral bronchiolitis management in hospitals in the UK after the publication of NICE guideline

Barr, Rachael; Carande, Elliott J; Pollard, Andrew J.; Drysdale, Simon B.

doi:10.1016/j.jcv.2018.06.011

Cited by 9 publications

(5 citation statements)

References 6 publications

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“…Previous studies carried out in hospitalized bronchiolitis patients also showed an improvement in the use of medications after the publication of the guidelines. In England, a similar study investigated the improvement in clinical practice after the 2015 NICE guidelines [15] and found a decrease in the use of salbutamol (from 47 to 30%), 3HS (from 55 to 33%), corticosteroids (from 7 to 2%), and epinephrine (from 22 to 12%) [25]. Another study conducted in the United States after implementation of the 2006 AAP guidelines showed a reduction in the use of nebulized medications (from 64.6 to 58%) and corticosteroids (from 24.7 to 16.3%) [26].…”

Section: Discussionmentioning

confidence: 99%

Management of Hospitalized Respiratory Syncytial Virus Bronchiolitis in the Pediatric Ward in Spain: Assessing the Impact of a New Clinical Practice Protocol

et al. 2021

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Background Bronchiolitis caused by the respiratory syncytial virus (RSV) is the main reason for hospitalization in infants. Supportive care is the mainstay of treatment, and tests are restricted to a few indications. During 2015, our hospital bronchiolitis protocol (2015 HBP) was updated according to the latest practice guidelines. Objective The objective of this study was to assess implementation of the 2015 HBP and the clinical outcome of children aged ≤ 24 months with RSV bronchiolitis admitted to a pediatric ward. Methods We compared the use of treatments and tests, hospital length of stay (LOS), and oxygen requirements before imple-

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Section: Discussionmentioning

confidence: 99%

Management of Hospitalized Respiratory Syncytial Virus Bronchiolitis in the Pediatric Ward in Spain: Assessing the Impact of a New Clinical Practice Protocol

et al. 2021

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“…19 A national survey looking at management practices of bronchiolitis across the UK found that routine testing of hospitalized infants for respiratory viruses dropped from 72% prior to the NICE guideline publication to 44% after. 25…”

Section: Clinical Usefulness Of Respiratory Virus Testingmentioning

confidence: 99%

“…8 A national survey in the UK found that individual trusts use a variety of cohorting practices including cohorting infants with the same causative virus, cohorting those with RSV, cohorting all infants with a clinical diagnosis of bronchiolitis in cubicles and cohorting all infants with a clinical diagnosis of bronchiolitis together, regardless of the causative virus. 25 These practices did not change significantly with the publication of the NICE guidance in 2015. 25 The AAP guideline recommends decontamination of hands with alcohol-based gel before and after every patient contact when managing patients with RSV.…”

Section: Transmission Of Rsv and Preventing Nosocomial Infections In mentioning

confidence: 99%

“…25 These practices did not change significantly with the publication of the NICE guidance in 2015. 25 The AAP guideline recommends decontamination of hands with alcohol-based gel before and after every patient contact when managing patients with RSV. 11 A systematic review of infection control measures to prevent nosocomial RSV transmission found that multicomponent interventions appeared to be most effective, with reductions in transmission of up to 50%.…”

Section: Transmission Of Rsv and Preventing Nosocomial Infections In mentioning

confidence: 99%

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Respiratory syncytial virus: diagnosis, prevention and management

Barr

Green

Sande

et al. 2019

Therapeutic Advances in Infection

Self Cite

102

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Respiratory syncytial virus (RSV) is responsible for a large burden of disease globally and can present as a variety of clinical syndromes in children of all ages. Bronchiolitis in infants under 1 year of age is the most common clinical presentation hospitalizing 24.2 per 1000 infants each year in the United Kingdom. RSV has been shown to account for 22% of all episodes of acute lower respiratory tract infection in children globally. RSV hospitalization, that is, RSV severe disease, has also been associated with subsequent chronic respiratory morbidity. Routine viral testing in all children is not currently recommended by the United Kingdom National Institute for Health and Care Excellence (NICE) or the American Academy of Pediatrics (AAP) guidance and management is largely supportive. There is some evidence for the use of ribavirin in severely immunocompromised children. Emphasis is placed on prevention of RSV infection through infection control measures both in hospital and in the community, and the use of the RSV-specific monoclonal antibody, palivizumab, for certain high-risk groups of infants. New RSV antivirals and vaccines are currently in development. Ongoing work is needed to improve the prevention of RSV infection, not only because of the acute morbidity and mortality, but also to reduce the associated chronic respiratory morbidity after severe infection.

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“…However, there are likely variations in compliance with such guidelines, e.g. as shown in with bronchiolitis management [28].…”

Section: Introductionmentioning

confidence: 99%

Determinants of accident and emergency attendances and emergency admissions in infants: birth cohort study

Nath

Zylbersztejn

Viner

et al. 2022

BMC Health Serv Res

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Background There is limited understanding of the drivers of increasing infant accident and emergency (A&E) attendances and emergency hospital admissions across England. We examine variations in use of emergency hospital services among infants by local areas in England and investigate the extent to which infant and socio-economic factors explain these variations. Methods Birth cohort study using linked administrative Hospital Episode Statistics data in England. Singleton live births between 1-April-2012 and 31-March-2019 were followed up for 1 year; from 1-April-2013 (from the discharge date of their birth admission) until their first birthday, death or 31-March-2019. Mixed effects negative binomial models were used to calculate incidence rate ratios for A&E attendances and emergency admissions and mixed effects logistic regression models estimated odds ratio of conversion (the proportion of infants subsequently admitted after attending A&E). Models were adjusted for individual-level factors and included a random effect for local authority (LA). Results The cohort comprised 3,665,414 births in 150 English LAs. Rates of A&E attendances and emergency admissions were highest amongst: infants born < 32 weeks gestation; with presence of congenital anomaly; and to mothers < 20-years-old. Area-level deprivation was positively associated with A&E attendance rates, but not associated with conversion probability. A&E attendance rates were highest in the North East (916 per 1000 child-years, 95%CI: 911 to 921) and London (876 per 1000, 95%CI: 874 to 879), yet London had the lowest emergency admission rates (232 per 1000, 95%CI: 231 to 234) and conversion probability (25% vs 39% in South West). Adjusting for individual-level factors did not significantly affect variability in A&E attendance and emergency admission rates by local authority. Conclusions Drivers of A&E attendances and emergency admissions include individual-level factors such being born premature, with congenital anomaly and from socio-economically disadvantaged young parent families. Support for such vulnerable infants and families should be provided alongside preventative health care in primary and community care settings. The impact of these services requires further investigation. Substantial geographical variations in rates were not explained by individual-level factors. This suggests more detailed understanding of local and underlying service-level factors would provide targets for further research on mechanisms and policy priority.

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Change in viral bronchiolitis management in hospitals in the UK after the publication of NICE guideline

Abstract: Overall there were modest but important improvements in the reported management of bronchiolitis after the publication of the NICE guideline.

Cited by 9 publications

References 6 publications

Management of Hospitalized Respiratory Syncytial Virus Bronchiolitis in the Pediatric Ward in Spain: Assessing the Impact of a New Clinical Practice Protocol

Management of Hospitalized Respiratory Syncytial Virus Bronchiolitis in the Pediatric Ward in Spain: Assessing the Impact of a New Clinical Practice Protocol

Respiratory syncytial virus: diagnosis, prevention and management

Determinants of accident and emergency attendances and emergency admissions in infants: birth cohort study

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