Bronchiolitis management by the Belgian paediatrician: discrepancies between evidence-based medicine and practice.
There is no therapy with proven effect on bronchiolitis outcome. This leads to large variations in its management between different countries. In order to evaluate how this disease was managed in our country, a questionnaire was sent to all Belgian paediatricians. With a response rate above 40% of active paediatricians, we found that bronchodilators (74.7% vs. 77.2%), physiotherapy (76.2% vs. 85.6%) and antibiotics (63.8% vs. 74.4%) were still largely prescribed in in- and outpatient settings respectively, corticosteroids (orally or intravenously) being prescribed more often in hospitals (54.3% vs. 17.0%). There were also some variations in admission criteria (minimal age 2 months (75%) to 6 months (8.2%), lower limit for oxygen saturation: 90% (21.5%) to 95% (26.5%)) and 1/3 of the respondents did not use pulse oxymetry to evaluate hypoxaemia in infants with bronchiolitis. Logistic regression analyses allowed us to identify patterns of prescription based on age, type and level of activity and language.


CONCLUSIONS
Many therapies with no proven effect are still used by Belgian paediatricians to treat children with bronchiolitis. Based on these results, we believe that publishing national guidelines will allow a reduction in the cost associated with this disease.
de Bilderling
G
G
Service de Pédiatrie Clinique de Mont-Godinne Université Catholique de Louvain Avenue Thérasse 5530 Yvoir, Belgium. Georges.Debilderling@pedi.ucl.ac.be
Bodart
E
E
D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001530:Belgium; D001990:Bronchiolitis, Viral / Q000175:diagnosis / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D019317:Evidence-Based Medicine; D005260:Female; D019538:Health Care Surveys; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D010372:Pediatrics / Q000379:methods*; D010818:Practice Patterns, Physicians'; D011379:Prognosis; D012138:Respiratory Therapy / Q000379:methods; D018570:Risk Assessment; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents