title: Management of Bronchiolitis in Community Hospitals in Ontario: a Multicentre Cohort Study.
abstract: OBJECTIVE
  Bronchiolitis is the leading cause of hospital admission for infants, but few studies have examined management of this condition in community hospital settings. We reviewed the management of children with bronchiolitis presenting to community hospitals in Ontario.
  
  
  METHODS
  We retrospectively reviewed a consecutive cohort of infants less than 12 months old with bronchiolitis who presented to 28 Ontario community hospitals over a two-year period. Bronchiolitis was defined as first episode of wheezing associated with signs of an upper respiratory tract infection during respiratory syncytial virus season.
  
  
  RESULTS
  Of 543 eligible children, 161 (29.7%, 95% Confidence Interval (CI) 22.3 to 37.0%) were admitted to hospital. Hospital admission rates varied widely (Interquartile Range 0%-40.3%). Bronchodilator use was widespread in the emergency department (ED) (79.7% of patients, 95% CI 75.0 to 84.5%) and on the inpatient wards (94.4% of patients, 95% CI 90.2 to 98.6%). Salbutamol was the most commonly used bronchodilator. At ED discharge 44.7% (95% CI 37.5 to 51.9%) of patients were prescribed a bronchodilator medication. Approximately one-third of ED patients (30.8%, 95% CI 22.7 to 38.8%), 50.3% (95% CI 37.7 to 63.0%) of inpatients, and 23.5% (95% CI 14.4 to 32.7) of patients discharged from the ED were treated with corticosteroids. The most common investigation obtained was a chest x-ray (60.2% of all children; 95% CI 51.9 to 68.5%).
  
  
  CONCLUSIONS
  Infants with bronchiolitis receive medications and investigations for which there is little evidence of benefit. This suggests a need for knowledge translation strategies directed to community hospitals.
authors.affiliation: *Departments of Pediatrics and Emergency Medicine,University of Ottawa,Ottawa,ON.
authors.forename: Amy C
authors.initials: AC
authors.lastname: Plint
authors.affiliation: †Clinical Epidemiology Program,Ottawa Hospital Research Institute,Ottawa,ON.
authors.forename: Monica
authors.initials: M
authors.lastname: Taljaard
authors.affiliation: §Children's Hospital Research Institute,Ottawa,ON.
authors.forename: Candice
authors.initials: C
authors.lastname: McGahern
authors.affiliation: ¶Department of Nursing,University of Alberta,Edmonton,AB.
authors.forename: Shannon D
authors.initials: SD
authors.lastname: Scott
authors.affiliation: §Children's Hospital Research Institute,Ottawa,ON.
authors.forename: Jeremy M
authors.initials: JM
authors.lastname: Grimshaw
authors.affiliation: **Pediatrics,University of Manitoba,Winnipeg,MB.
authors.forename: Terry P
authors.initials: TP
authors.lastname: Klassen
authors.affiliation: ††Departments of Pediatrics and Physiology and Pharmacology,University of Calgary,Calgary,AB.
authors.forename: David W
authors.initials: DW
authors.lastname: Johnson
mesh_terms: D000420:Albuterol / Q000627:therapeutic use*; D001988:Bronchiolitis / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D001993:Bronchodilator Agents / Q000494:pharmacology / Q000627:therapeutic use*; D016000:Cluster Analysis; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006764:Hospitals, Community; D006801:Humans; D015994:Incidence; D007223:Infant; D007902:Length of Stay; D008297:Male; D015588:Observer Variation; D009864:Ontario; D010343:Patient Admission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D001993:Bronchodilator Agents; D000420:Albuterol
keywords: bronchiolitis; children; emergency department