title: Management of bronchiolitis in the emergency department: impact of evidence-based guidelines?
abstract: OBJECTIVE
  Recent practice guidelines from the American Academy of Pediatrics recommend limiting use of bronchodilators, corticosteroids, antibiotics, and diagnostic testing for patients with bronchiolitis. We sought to determine the association of the evidence-based guidelines with bronchiolitis care in the emergency department (ED).
  
  
  METHODS
  We analyzed data from the National Hospital Ambulatory Medical Care Survey, a nationally representative sample of ED visits. We compared utilization for patient visits before and after the publication of the guidelines. We used logistic regression to determine the association of the availability of the guidelines with resource utilization.
  
  
  RESULTS
  Bronchodilators were used in 53.8% of patient visits with no differences noted after the introduction of the guidelines (53.6% vs 54.2%, P = .91). Systemic steroids were used in 20.4% of patient visits, and antibiotics were given in 33.2% of visits. There were no changes in the frequency of corticosteroid (21.9% vs 17.8%, P = .31) or antibiotic (33.6% vs 29.7%, P = .51) use. There was an associated decrease in use of chest x-rays (65.3% vs 48.6%, P = .005). This association remained significant after adjusting for patient and hospital characteristics with an adjusted odds ratio of 0.41 (95% confidence interval 0.26-0.67).
  
  
  CONCLUSIONS
  For patients seen in the ED with bronchiolitis, utilization of diagnostic imaging has decreased with the availability of the American Academy of Pediatrics practice guidelines. However, there has not been an associated decrease in use of nonrecommended therapies. Targeted efforts will likely be required to change practice significantly.
authors: Department of Pediatrics, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA. lara.johnson@ttuhsc.edu
authors: Lara W
authors: LW
authors: Johnson
authors: Janie
authors: J
authors: Robles
authors: Amanda
authors: A
authors: Hudgins
authors: Shea
authors: S
authors: Osburn
authors: Devona
authors: D
authors: Martin
authors: Amy
authors: A
authors: Thompson
mesh_terms: D000367:Age Factors; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001988:Bronchiolitis / Q000188:drug therapy* / Q000453:epidemiology; D001993:Bronchodilator Agents / Q000627:therapeutic use; D002675:Child, Preschool; D004363:Drug Utilization / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital; D019317:Evidence-Based Medicine; D005938:Glucocorticoids / Q000627:therapeutic use; D019983:Guideline Adherence; D019538:Health Care Surveys; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015999:Multivariate Analysis; D017410:Practice Guidelines as Topic; D013902:Radiography, Thoracic / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents; D001993:Bronchodilator Agents; D005938:Glucocorticoids