title: Management of acute bronchiolitis in emergency wards in Spain: variability and appropriateness analysis (aBREVIADo Project).
abstract: Most patients with acute bronchiolitis have a mild course and only require outpatient care. However, some of them have to go to emergency departments, because they have respiratory distress or feeding problems. There, they frequently receive diagnostic and therapeutic procedures. We want to know the variability and appropriateness of these procedures. A cross-sectional study (October 2007 to March 2008) was carried out on 2,430 diagnosed cases of bronchiolitis in hospital emergency departments, which required no hospitalization. An analysis of the appropriateness of the treatments was made in 2,032 cases gathered in ten departments with at least 100 cases, using as criterion the recommendations of a consensus conference. We estimated the adjusted percentages of each department. Most of the bronchiolitis were mild, in spite that they underwent multiple diagnostic and therapeutic procedures. In the acute phase, different treatments were used: inhaled beta 2 agonists (61.4%), antipyretics (17.1%), oral steroids (11.3%), and nebulized adrenaline (9.3%). In the maintenance phase, the most common treatments were: inhaled beta 2 agonists (50.5%), oral steroids (17%), oral beta 2 agonists (14.9%), and antibiotics (6.1%). The 64% of the treatments used in the acute phase and the 55.9% in the maintenance phase were considered inappropriate in the appropriateness analysis; a great heterogeneity among centers was found.
  
  
  CONCLUSIONS
  There are discrepancies between clinical practice and evidence-based management of bronchiolitis in Spanish emergency departments. Inappropriate treatments were used in more than half of patients. The wide variation between centers shows the influence of local prescribing habits and reveals the scope for improvement.
authors.affiliation: Pediatric Service, Hospital Virgen de la Concha, C/Jardines Eduardo Barrón 1 bis 3°, 49018, Zamora, Spain. cochoas@meditex.es
authors.forename: Carlos
authors.initials: C
authors.lastname: Ochoa Sangrador
authors.forename: Javier
authors.initials: J
authors.lastname: González de Dios
mesh_terms: D000553:Ambulatory Care / Q000592:standards* / Q000706:statistics & numerical data; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001988:Bronchiolitis / Q000175:diagnosis / Q000628:therapy; D001993:Bronchodilator Agents / Q000627:therapeutic use; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003948:Diagnostic Techniques, Respiratory System / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010102:Oxygen Inhalation Therapy / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012720:Severity of Illness Index; D013030:Spain
chemical_list: D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D001993:Bronchodilator Agents