Practice Variations between Emergency Physicians and Pediatricians in Treating Acute Bronchiolitis in the Emergency Department: A Nationwide Study.
BACKGROUND
Although supportive care is the mainstay management for acute bronchiolitis, non-evidence-based diagnostic testing and medications remain common in emergency departments (EDs).


OBJECTIVE
Our aim was to compare emergency physicians (EPs) and pediatricians practice patterns in the management of acute bronchiolitis in the ED.


METHODS
A cross-sectional study was conducted by using registration and claims datasets from 2008 to 2011. Patients with acute bronchiolitis were divided into EP group and pediatrician group.


RESULTS
A total of 2174 patients were enrolled. The diagnostic tests used, including chest x-ray (63.7% vs. 46%; adjusted odds ratio [OR] = 2.27; 95% CI 1.77-2.91), complete blood count (33.2% vs. 21.8%; adjusted OR = 1.74; 95% CI 1.33-2.26), C-reactive protein (35.1% vs. 22.6%; adjusted OR = 1.79; 95% CI 1.38-2.33), blood culture (23.9% vs. 14.3%; adjusted OR = 1.79; 95% CI 1.33-2.39), and arterial blood gas (3.7% vs. 1.8%, adjusted OR = 2.38; 95% CI 1.21-4.67), were higher in the EP group than in the pediatrician group. Intravenous fluid administration was also higher in the EP group (20.8% vs. 3.5%; adjusted OR = 7.49; 95% CI 5.12-10.8). In addition, EPs more frequently arranged for hospital admissions (36% vs. 19.5%; adjusted OR = 2.51; 95% CI 1.15-3.26).


CONCLUSIONS
Both EPs and pediatricians had high rates of ordering diagnostic testing for acute bronchiolitis patients in ED. Compared with pediatricians, EPs used more diagnostic tests for the patients with acute bronchiolitis in ED.
Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan; Department of Emergency Medicine, Chung Shan Medical University, Taichung, Taiwan.
Sai-Wai
SW
Ho
Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan; Department of Emergency Medicine, Chung Shan Medical University, Taichung, Taiwan.
Ka-Yi
KY
Huang
Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan; Department of Emergency Medicine, Chung Shan Medical University, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.
Ying-Hock
YH
Teng
School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Division of Allergy, Asthma and Rheumatology, Department of Pediatrics, Chung Shan Medical University Hospital, Taichung, Taiwan.
Min-Sho
MS
Ku
School of Health Policy and Management, Chung Shan Medical University, Taichung, Taiwan.
Jeng-Yuan
JY
Chiou
D000208:Acute Disease; D001769:Blood / Q000382:microbiology; D001772:Blood Cell Count; D001784:Blood Gas Analysis; D001988:Bronchiolitis / Q000175:diagnosis* / Q000628:therapy*; D002097:C-Reactive Protein / Q000378:metabolism; D015169:Colony Count, Microbial; D003430:Cross-Sectional Studies; D004635:Emergency Medicine; D004636:Emergency Service, Hospital; D005260:Female; D005440:Fluid Therapy; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008297:Male; D010372:Pediatrics; D010818:Practice Patterns, Physicians'; D013902:Radiography, Thoracic; D013624:Taiwan
D002097:C-Reactive Protein
acute bronchiolitis; emergency department; emergency physicians; pediatricians; practice variations