Variations in bronchiolitis management between five New Zealand hospitals: can we do better?
OBJECTIVE
To determine the current management of bronchiolitis by five major New Zealand hospitals and to identify areas for improvement.


METHODS
Lists of infants under 1 year of age admitted with bronchiolitis during 1998 were obtained from the casemix offices of the five largest New Zealand hospitals with paediatric services. Hospital records from a random sample of these admissions were reviewed.


RESULTS
Out of the 409 infants admitted overnight, 8% had been born less than or=32 weeks gestation and 53% were aged younger than 6 months. Overall, 59% received oxygen, 21% had nasogastric fluids, 22% had intravenous fluids, 34% were prescribed antibiotics, 42% received bronchodilators and 60% had a chest radiograph. Respiratory secretions were collected for viral studies from 58% of infants and, in 59%, respiratory syncytial virus was detected. Significant variations in management were detected between hospitals. The overall proportion of infants requiring oxygen, intravenous or nasogastric fluids (65%) was significantly higher than that found in a 1986-1988 Christchurch study where only 25% received one or more of these interventions (P < 0.001).


CONCLUSIONS
Opportunities exist to rationalize bronchiolitis management in New Zealand with potential cost savings, particularly by reducing the number of chest radiographs and prescribing of unnecessary antibiotics and bronchodilators.
Vogel
A M
AM
Department of Paediatrics, South Auckland Clinical School, University of Auckland, Starship Children's Hospital, Auckland, New Zealand. alvogel@middlemore.co.nz
Lennon
D R
DR
Harding
J E
JE
Pinnock
R E
RE
Graham
D A
DA
Grimwood
K
K
Pattemore
P K
PK
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001988:Bronchiolitis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000628:therapy*; D001993:Bronchodilator Agents / Q000627:therapeutic use; D019317:Evidence-Based Medicine; D005260:Female; D005440:Fluid Therapy; D019983:Guideline Adherence; D006764:Hospitals, Community / Q000592:standards*; D006801:Humans; D007223:Infant; D007224:Infant Care / Q000592:standards*; D007231:Infant, Newborn; D007902:Length of Stay; D008297:Male; D009520:New Zealand; D010102:Oxygen Inhalation Therapy; D011859:Radiography; D012307:Risk Factors; D012720:Severity of Illness Index
D000900:Anti-Bacterial Agents; D001993:Bronchodilator Agents