Treatment for acute bronchiolitis before and after implementation of new national guidelines: a retrospective observational study from primary and secondary care in Oslo, Norway

Abstract

BackgroundAcute bronchiolitis treatment guidelines changed in Norway in 2013, no longer recommending the use of nebulised epinephrine. We aimed to assess whether these changes were successfully implemented in both primary and secondary care. Secondary aims were to compare the difference in management of acute bronchiolitis patients in primary and secondary care between 2009 and 2017.MethodsWe retrospectively registered data on demographics, clinical features and management from electronic medical records of all infants (<12 months of age) diagnosed with acute bronchiolitis at a primary care centre (Oslo Accident and Emergency Outpatient Clinic) and a secondary care centre (Oslo University Hospital) in Norway in 2009, 2014 and 2017. All patient records were individually reviewed to ensure data accuracy.ResultsWe included 680 (36.3%) patients from primary care and 1195 (63.7%) from secondary care. There was a reduction in the use of nebulised epinephrine from 2009 to 2017 from 66.9% to 16.1% of cases (p<0.001) in primary care and from 59.1% to 4.9% (p<0.001) in secondary care. In parallel, there was an increase in the use of nebulised saline treatment, from 0.8% to 53.8% (p<0.001) in primary care and from 39.3% to 65.3% (p<0.001) in secondary care. The decrease in the use of nebulised racemic epinephrine occurred earlier in secondary care than in primary care; 13.4% vs 56.1%, respectively, in 2014.ConclusionsImplementation of the new guidelines on the treatment of acute bronchiolitis was successfully implemented in both primary and secondary care.

Factors associated with nonadherence to the American Academy of Pediatrics 2014 bronchiolitis guidelines: A retrospective study

“…radiography was predominantly prescribed to hospitalized children admitted to ICU, possibly to rule out other pathologies. Our results are, overall, in line with previous reports [8][9][10][11]. The strength of our study lies first, in that we were able to retrieve robust data from patients presenting with acute bronchiolitis between three distinct periods of observation.…”

“…Indeed, our study was based on data retrieved from medical charts that included clinical parameters as well as prescriptions for medications and investigations both pre-ED presentation and in hospital. In contrast, most published reports have relied on in-hospital data only, sometimes pre-dating current management guidelines, retrieved from physician questionnaires or hospital billing databases lacking clinical information, focussing only on medication prescriptions and ignoring investigations [8][9][10][11].…”

“…Avoiding unnecessary interventions not only benefits the patient, it is also essential to counteract rising healthcare costs. Many studies have reported increasing adherence to the 2014 AAP guideline, with decreasing use of nonevidence-based interventions, mainly bronchodilators [8][9][10][11]. Achievable benchmarks of care (ABC) for bronchiolitis have also been defined [12,13] in order to improve the quality of healthcare processes and thereby reduce the number of unnecessary interventions.…”

Fem år med Gjør kloke valg – hjelper det?

“…Artroskopisk meniskreseksjon etter 50 års alder, et ortopedisk inngrep med usikker behandlingsgevinst, ble redusert med 63 % fra 2013 til 2017 (5). Ved Oslo universitetssykehus falt andelen barn med bronkiolitt som fikk inhalasjoner med racemisk adrenalin, fra 59 % i 2009 til 5 % i 2017 (6).…”

Consideraciones fisiopatológicas y clínico-terapéuticas de la bronquiolitis en la población pediátrica

“…Por ende, los padres del paciente deben estar al tanto de todas las posibilidades, que conozcan los signos que va a presentar su hijo si su situación empeora, y que sepan las medidas que deban llevar a cabo en dicho caso (12). A continuación, se indican las distintas formas de tratar la enfermedad, conforme va empeorando el paciente: Desobstrucción nasal: asegura conservar la ventilación y que la vía aérea superior se mantenga permeable, ya que la disminución de secreciones reduce la probabilidad de complicaciones como la otitis (13)(14)(15). Tratamiento postural: elevar el punto de apoyo de la cabeza en la cuna.…”