Pediatricians' attitudes and costs of bronchiolitis in the emergency department: A prospective multicentre study

García‐Marcos, Luis; Valverde-Molina, J.; Pavlovic-Nesic, Svetlana; Claret-Teruel, Gemma; Peñalba-Citores, Ana C.; Nehme-Álvarez, D.; Korta-Murúa, Javier; Sánchez-Etxaniz, Jesús; Alonso-Salas, María Teresa; Campos-Calleja, C.; Fernández-Villar, Andrés; Rodríguez, Julián

doi:10.1002/ppul.22906

Cited by 20 publications

(17 citation statements)

References 35 publications

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“…2 -5 Bronchiolitis also represents a major health care and financial burden in other developed nations. 5,6 There is a lack of evidence of benefit of pharmacologic interventions in bronchiolitis, and management guidelines only recommend the use of hydration, oxygenation, and airway support. 1, 7 -13 Previous studies of severe bronchiolitis 9, 14 -20 have been focused on hospitalization, which encompasses a broad range of disease severity and the inpatient population, rather than infants presenting to the emergency department (ED).…”

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confidence: 99%

Predicting Escalated Care in Infants With Bronchiolitis

Freire¹,

Kuppermann

Zemek

et al. 2018

Pediatrics

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BACKGROUND AND OBJECTIVES:Early risk stratification of infants with bronchiolitis receiving airway support is critical for focusing appropriate therapies, yet the tools to risk categorize this subpopulation do not exist. Our objective was to identify predictors of "escalated care" in bronchiolitis. We hypothesized there would be a significant association between escalated care and predictors in the emergency department. We subsequently developed a risk score for escalated care. METHODS:We conducted a retrospective cohort study of previously healthy infants aged <12 months with bronchiolitis. Our primary outcome was escalated care (ie, hospitalization with high-flow nasal cannula, noninvasive or invasive ventilation, or intensive care admission). The predictors evaluated were age, prematurity, day of illness, poor feeding, dehydration, apnea, nasal flaring and/or grunting, respiratory rate, oxygen saturation, and retractions. . One of 217 (0.5%) infants without predictors received escalated care. The risk score ranged from 0 to 14 points, with the estimated risk of escalated care from 0.46% (0 points) to 96.9% (14 points). The area under the curve was 85%. CONCLUSIONS:We identified variables measured in the emergency department predictive of escalated care in bronchiolitis and derived a risk score to stratify risk of this outcome. This score may be used to aid management and disposition decisions.

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confidence: 99%

Predicting Escalated Care in Infants With Bronchiolitis

Freire¹,

Kuppermann

Zemek

et al. 2018

Pediatrics

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“…Acute bronchiolitis is an infection of the lower respiratory tract, typical of infants, most commonly caused by respiratory syncytial virus (RSV) . It is the leading cause of hospitalization for respiratory disease in infants, with an estimated 80,000 cases and 10,000 hospital days in Portugal each year, constituting a significant burden in health expenditure …”

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confidence: 99%

A randomized trial of nebulized 3% hypertonic saline with salbutamol in the treatment of acute bronchiolitis in hospitalized infants

Flores

Mendes

Neto

2015

Pediatric Pulmonology

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Summary. Objective: Acute bronchiolitis is a common disorder of infants that often results in hospitalization. Apart from supportive care, no therapy has been shown to influence the course of the disease, except for a possible effect of nebulized hypertonic saline (HS). To determine whether this does have beneficial effects on length of stay in hospital or on severity scores, we undertook a double-blind, randomized, controlled trial in a pediatric department of a Portuguese hospital. Methods: Previously healthy infants, younger than 12 months, hospitalized with mild-to-moderate acute viral bronchiolitis were randomized to receive either nebulized 3% (hypertonic, HS) or 0.9% (normal, NS) saline during their entire hospital stay. Primary endpoints were: length of hospital stay and severity scores on each day of hospitalization. Need for supplemental oxygen, further add-on medications and adverse effects were also analyzed. Results: Sixty-eight patients completed the study (HS: 33; NS: 35). The median length of hospital stay did not differ between groups: HS: 5.6 AE 2.3 days; NS: 5.4 AE 2.1 days (P ¼ 0.747). We found no difference between groups in severity scores from day 1 to day 4. There were no differences in need for supplemental oxygen or add-on medications. Patients in HS group had significantly more cough (46% vs. 20%, P ¼ 0.025) and rhinorrhoe (58% vs. 31%, P ¼ 0.30). Conclusion: This study does not support the use of nebulized HS over NS in therapy of hospitalized children with mild-to-moderate acute viral bronchiolitis. Pediatr Pulmonol.

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“…1,2 In the United States, annual bronchiolitisrelated hospitalization expenses exceed $500 million 3 and other western countries have similar challenges with the costs of managing bronchiolitis. 4,5 Because effective therapies remain elusive, clinical guidelines advocate for supportive measures and discourage the use of pharmacotherapy and diagnostic testing. 6 -13 Nonetheless, the desire to improve the child's well-being, combined with the lack of evidencebased therapeutic options, has led to the continued use of resources that provide little benefit.…”

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confidence: 99%

Practice Variation in Acute Bronchiolitis: A Pediatric Emergency Research Networks Study

et al. 2017

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Pediatricians' attitudes and costs of bronchiolitis in the emergency department: A prospective multicentre study

Abstract: Although relatively low at the individual level (€249.2, mean total cost) the costs for just the ED expenses of bronchiolitis in Spain would add up to about €20 million per year.

Cited by 20 publications

References 35 publications

Predicting Escalated Care in Infants With Bronchiolitis

Predicting Escalated Care in Infants With Bronchiolitis

A randomized trial of nebulized 3% hypertonic saline with salbutamol in the treatment of acute bronchiolitis in hospitalized infants

Practice Variation in Acute Bronchiolitis: A Pediatric Emergency Research Networks Study

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