Impact of Guidelines Publication on Acute Bronchiolitis Management: 10-Year Experience from a Tertiary Care Center in Italy

Abstract

Bronchiolitis is the most common lower respiratory tract infection in infants. According to evidence-based guidelines, diagnosis is clinical, there is no need for routine use of laboratory or instrumental tests and therapy is primarily supportive, based on oxygen and adequate fluid supplementation. Nevertheless, unnecessary diagnostic tests and pharmacological treatments are still very common. The aim of this retrospective cohort study was to evaluate how the management of bronchiolitis has changed in the last ten years in a Tertiary Care Center in Italy, assessing adherence to national guidelines. Considering the publication of the Italian inter-society consensus document in 2014, we compared patients admitted in the prior four epidemic seasons with patients admitted in the latter six epidemic seasons. The comparison between the two groups showed a significant reduction in the prescription of systemic corticosteroids (58.9% vs. 41.8%, p < 0.001), nebulized epinephrine (73.8% vs. 38.3%, p < 0.001) and antibiotics (59.5% vs. 42.3%, p < 0.001), together with a drastic decrease in the use of chest X-ray (92.2% vs. 54.4%, p < 0.001). On the contrary, the use of inhaled salbutamol remained substantially stable over time (39.4% vs. 37.6%, p = 0.505). Despite the encouraging results, further efforts are needed to limit the prescription of ineffective therapies like antibiotics and inhaled salbutamol.

Impact of the publication of the Italian guidelines for bronchiolitis on the management of hospitalized children in Pisa, Italy

“…Our results are completely in line with those reported by Barbieri et al evaluating the impact of the guidelines on clinical practice in Italian pediatric primary care 18 as well as with those from the study held by Biagi et al in a tertiary care center in Bologna, Italy. 19 Nevertheless, differently from our study, in the latter they found a reduction in antibiotics use (59.5% vs. 42.3%). Moreover, while they reported a significant reduction in the average length of hospitalization (5.5 vs. 4.0 days, p < 0.001), in our study such parameter did not significantly change over time (7.0 vs 6.4 days, p = 0.0649).…”

“…Our data shows that the publication and spread of the national guidelines on bronchiolitis contributed to modifying clinical practice in hospitalized children with bronchiolitis in our Unit, with significant reduction in the use of chest X‐rays, blood testing and inhaled or systemic corticosteroids, while no difference was found in the use of antibiotics and of inhaled β2 agonists. Our results are completely in line with those reported by Barbieri et al evaluating the impact of the guidelines on clinical practice in Italian pediatric primary care 18 as well as with those from the study held by Biagi et al in a tertiary care center in Bologna, Italy 19 . Nevertheless, differently from our study, in the latter they found a reduction in antibiotics use (59.5% vs. 42.3%).…”

“…Recent papers by Barbieri et al and Biagi et al showed that the Italian guidelines publication contributed to improving the appropriateness of prescriptions respectively in both primary and hospital care. 18,19 The aim of this single-center study conducted in Pisa, Italy, was to assess the impact of the publication of the national guidelines on the management of children hospitalized for bronchiolitis in our Unit between 2010 and 2019.…”

Bronchiolitis 2021–2022 epidemic: multicentric analysis of the characteristics and treatment approach in 214 children from different areas in Italy

“…In conclusion, in our study of 214 children with bronchiolitis diagnosed and treated in four pediatric Italian centers, we observed a favorable prognosis in all cases, with requirement of ICU limited to a minority of patients. These findings are in keeping with those reported in a contemporary, comparable, multicenter setting in Italy [ 36 , 37 ]. The vast majority of children was treated in the pediatric wards, equipped with low-flow and high-flow nasal cannula for oxygen therapy.…”

Different Pediatric Acute Care Settings Influence Bronchiolitis Management: A 10-Year Retrospective Study

“…The implementation of clinical practice guidelines has been reported to result in reductions in diagnostic and therapeutic resource use [ 18 ]; nonetheless, many children continue to undergo unnecessary tests and no evidence-based therapies [ 19 , 20 ]. According to this, in a previous study we have evaluated the impact of the Italian guidelines on the management of bronchiolitis in our Tertiary Care Center [ 20 ]. This study revealed that further efforts are needed to limit the prescription of ineffective therapies, particularly antibiotics.…”