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

Carande, Elliott J; Cheung, C Ronny; Pollard, Andrew J.; Drysdale, Simon B.

doi:10.1136/thoraxjnl-2017-211180

Cited by 10 publications

(9 citation statements)

References 9 publications

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“…reported management of viral bronchiolitis after the publication of the NICE guideline. We have previously shown the NICE guideline resulted in similar modest improvements in the primary care management of bronchiolitis [6].…”

Section: Discussionmentioning

confidence: 88%

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

Barr

Carande

Pollard

et al. 2018

Journal of Clinical Virology

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Section: Discussionmentioning

confidence: 88%

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

Barr

Carande

Pollard

et al. 2018

Journal of Clinical Virology

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“…This could be because it was administered in the emergency department prior to admission or was given to address parents’ dissatisfaction when their children were not getting any treatment. Reports indicate that a rationale for medication prescription by practitioners in bronchiolitis could be the expectation of parents [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

Bronchiolitis clinical practice guidelines implementation: surveillance study of hospitalized children in Jordan

et al. 2020

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Background: Bronchiolitis is a leading cause of hospital admissions and death in young children. Clinical practice guidelines (CPG) to diagnose and manage bronchiolitis have helped healthcare providers to avoid unnecessary investigations and interventions and to provide evidence-based treatment. Aim of this study is to determine the effect of implementing CPG for the diagnosis and management of bronchiolitis in a tertiary hospital in Jordan. Methods: The study compared children (age <24 months) diagnosed with bronchiolitis and who required admission to King Abdullah University Hospital in Irbid during the winter of 2017 (after CPG implementation) and age-matched children admitted in the winter of 2016. The proportion of patients receiving diagnostic tests and treatments in the two groups were compared.Results: Eighty-eight and 91 patients were diagnosed with bronchiolitis before and after CPG implementation, respectively. Respiratory syncytial virus rapid antigen detection testing decreased after CPG implementation [n=64 (72.7%) vs n=46 (50.5%), p=0.002]. However, there was no significant change in terms of other diagnostic tests. The use of nebulized salbutamol [n=44 (50%) vs n=29 (31.9%), p=0.01], hypertonic saline [n=39 (44.3%) vs n=8 (8.8%), p<0.001], and inappropriate antibiotics [n=31 (35.2%) vs n=15 (16.5%), p=0.004] decreased after CPG implementation. There was no difference in mean LOS (standard deviation; SD) between the pre- and post-CPG groups [3.5 (2) vs 4 (3.4) days, p=0.19]. The mean cost of stay (SD) was 449.4 (329.1) US dollars for pre-CPG compared to 507.3 (286.1) US dollars for the post-CPG group (p=0.24).Conclusion: We observed that the implementation of CPG for bronchiolitis diagnosis and management helped change physicians’ behavior toward evidence-based practices. However, adherence to guidelines must be emphasized to improve practices in developing countries, focusing on the rational use of diagnostic testing, and avoiding use of unnecessary medications when managing children with a diagnosis of bronchiolitis.

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“…Care of the child with bronchiolitis varies greatly, with reports of unnecessary testing and therapies reported in North America and Europe . There are many contributory factors, including differential thresholds for hospitalization, poor collaboration between ED, and inpatient teams, as well as the lack of consensus on an effective clinical assessment tool .…”

Section: Discussionmentioning

confidence: 99%

“…Care of the child with bronchiolitis varies greatly, with reports of unnecessary testing and therapies reported in North America and Europe. 18,19 There are many contributory factors, including differential thresholds for hospitalization, poor collaboration between ED, and inpatient teams, 18 as well as the lack of consensus on an effective clinical assessment tool. 10 An objective predictive tool that is noninvasive would greatly assist the ED physician in deciding which child with bronchiolitis would indeed benefit from inpatient observation and other supportive management strategies.…”

Section: Discussionmentioning

confidence: 99%

Nasal high‐mobility group box 1 and caspase in bronchiolitis

Chong

Lai

Castillo

et al. 2018

Pediatric Pulmonology

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Objective Nasal biomarkers have potential to add objectivity to the clinical assessment of the child with bronchiolitis. We aim to study, if nasal caspase and high‐mobility group box 1 protein (HMGB1) levels differ between patients who were hospitalized and those discharged from the emergency department (ED), among patients with bronchiolitis. Methods Using an observational cross‐sectional study design, we recruited patients younger than 24 months presenting to the ED from September 1, 2015 to May 31, 2017 with a diagnosis of acute bronchiolitis. We described the patients’ clinical severity measured by the modified respiratory index score (RIS), and performed standardized collection and analysis of nasal caspase and HMGB1 levels. Results Among 85 patients recruited, the median age was 5.0 months (interquartile range, IQR 3.3‐7.2) and the median modified RIS score was 3 (IQR 2‐4). Hospitalized patients had a 2.4‐fold higher HMGB1 level than patients who were discharged from the ED (2.558 μg/mL [IQR 1.038‐5.125] vs 1.056 μg/mL [IQR 0.409‐2.395], P = 0.0013). There was no difference in median caspase level between hospitalized and discharged patients. The Area Under the Receiver Operating Characteristics curve predicting hospitalization was 0.7021 for HMGB1 compared to 0.5709 for RIS in this bronchiolitis cohort. Conclusions Our study findings show that nasal HMGB1 levels significantly differentiate between young children with bronchiolitis who were hospitalized compared to those fit for discharge. This exploratory study holds potential for future research on nasal HMGB1 for severity stratification in young children with acute bronchiolitis.

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

Cited by 10 publications

References 9 publications

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

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

Bronchiolitis clinical practice guidelines implementation: surveillance study of hospitalized children in Jordan

Nasal high‐mobility group box 1 and caspase in bronchiolitis

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