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Management of Bronchiolitis in Community Hospitals in Ontario: a Multicentre Cohort Study

  • Amy C. Plint (a1), Monica Taljaard (a2) (a3), Candice McGahern (a4), Shannon D. Scott (a5), Jeremy M. Grimshaw (a4) (a6), Terry P. Klassen (a7) and David W. Johnson (a8)...
Abstract
Abstract Objectives

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.

RÉSUMÉ Objectif

La bronchiolite est le principal motif d’hospitalisation des enfants en bas âge, mais peu d’études ont porté sur la prise en charge de la maladie, dans les hôpitaux communautaires. Les auteurs de l’étude ont donc examiné la prise en charge de la maladie chez les enfants traités dans les hôpitaux communautaires, en Ontario.

Méthode

Les auteurs ont procédé à un examen rétrospectif d’une cohorte d’enfants consécutifs, âgés de moins de 12 mois, qui souffraient d’une bronchiolite et qui ont été traités dans 28 hôpitaux communautaires en Ontario, sur une période de 2 ans. La bronchiolite a été définie comme un premier épisode de respiration sifflante, associé à des signes d’une infection des voies respiratoires supérieures durant la période du virus respiratoire syncytial.

Résultats

Sur 543 enfants admissibles à l’étude, 161 (29,7%; intervalle de confiance [IC] à 95% : 22,3 à 37,0%) ont été hospitalisés. Les taux d’admission à l’hôpital variaient énormément (intervalle interquartile : 0-40,3%). L’utilisation des bronchodilatateurs était courante au service des urgences (SU) (79,7% des patients; IC à 95% : 75,0 à 84,5%) ainsi qu’à l’étage (94,4% des patients; IC à 95% : 90,2 à 98,6%). Le salbutamol était le brochodilatateur le plus utilisé. Au moment du congé du SU, un brochodilatateur avait été prescrit à 44,7% (IC à 95% : 37,5 à 51,9%) des patients. Environ un tiers des patients traités au SU (30,8%; IC à 95% : 22,7 à 38,8%); 50,3% (IC à 95% : 37,7 à 63,0%) des enfants hospitalisés et 23,5% (IC à 95% : 14,4 à 32,7) des patients ayant obtenu leur congé du SU étaient traités par les corticostéroïdes. L’examen demandé le plus souvent était la radiographie des poumons (60,2% de tous les enfants; IC à 95% : 51,9 à 68,5%).

Conclusions

Les enfants en bas âge souffrant d’une bronchiolite reçoivent des médicaments et sont soumis à des examens pour lesquels il existe peu de données à l’appui de leurs avantages. Les résultats donnent à penser que des stratégies d’application des connaissances devraient être conçues à l’intention des hôpitaux communautaires.

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Copyright
Corresponding author
Correspondence to: Amy C. Plint, Children’s Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON, K1H 8L1. Email: plint@cheo.on.ca
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