Bronchiolitis management in pediatric emergency departments in Australia and New Zealand: a PREDICT study.
OBJECTIVE
Bronchiolitis is the most frequent reason for admission in infants. We set out to compare clinical practice guideline (CPG) recommendations and physician management of bronchiolitis at Paediatric Research in Emergency Departments International Collaborative (PREDICT) sites in Australia and New Zealand as a baseline for prospective trials.


METHODS
(i) Review of bronchiolitis CPGs from PREDICT sites. (ii) Survey of senior pediatric emergency physicians at PREDICT sites to determine management strategies in bronchiolitis.


RESULTS
All 11 PREDICT sites participated. Ten sites used a specific bronchiolitis CPG. beta-agonists were not recommended unless the child was older or asthma was suspected. Eight sites did not and 2 sites only recommended corticosteroids for older infants in whom asthma was likely. For rehydration, 7 sites recommended intravenous (i.v.) fluids exclusively or in the acute phase, with 3 recommending nasogastric (n.g.) fluids in the recovery phase or for difficult vascular access. Two sites recommended n.g. fluids for moderate and i.v. fluids for severe bronchiolitis. Physician response rate was 78/83 (94%). No medications were used for mild (94%) or moderate (83%) bronchiolitis. Inhaled beta-agonists were used by 5% for moderate and 18% for severe bronchiolitis. Steroids were not used by any physicians for mild or moderate and was used by only 3% for severe bronchiolitis. The preferred mode of rehydration was i.v. in 45%, n.g. in 49%, and either one depending on disease severity in 6%.


CONCLUSIONS
Management of bronchiolitis was similar across PREDICT sites. Practice is equally split between i.v. and n.g. rehydration. This reflects a lack of evidence which should be addressed through a multicenter comparative trial.
Babl
Franz E
FE
Emergency Department, Royal Children's Hospital, Melbourne, Vic., Australia. franz.babl@rch.org.au
Sheriff
Nisa
N
Neutze
Jocelyn
J
Borland
Meredith
M
Oakley
Ed
E
D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000318:Adrenergic beta-Agonists / Q000627:therapeutic use; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D001249:Asthma / Q000150:complications; D001315:Australia; D001988:Bronchiolitis / Q000150:complications / Q000628:therapy*; D001993:Bronchodilator Agents / Q000627:therapeutic use; D002675:Child, Preschool; D003131:Combined Modality Therapy; D000075202:Contraindications; D003681:Dehydration / Q000209:etiology / Q000628:therapy; D019468:Disease Management; D004636:Emergency Service, Hospital; D005440:Fluid Therapy / Q000379:methods; D006801:Humans; D007223:Infant; D007262:Infusions, Intravenous; D007391:International Cooperation; D007441:Intubation, Gastrointestinal; D009520:New Zealand; D010102:Oxygen Inhalation Therapy; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D015532:Rehydration Solutions / Q000008:administration & dosage / Q000627:therapeutic use
D000305:Adrenal Cortex Hormones; D000318:Adrenergic beta-Agonists; D018927:Anti-Asthmatic Agents; D001993:Bronchodilator Agents; D015532:Rehydration Solutions