Treatment of bronchiolitis in children varies widely and often results in unnecessary tests and antibiotics

Considerable differences exist in the treatment of bronchiolitis at children's hospitals across the United States, according to a study from Children's Hospital and Regional Medical Center in Seattle published in the April 1 issue of Pediatrics. The study, the largest to be conducted on the treatment of infants hospitalized with bronchiolitis, demonstrates the need for improvement nationally in the quality of care provided for bronchiolitis patients.

The findings also suggest that decreasing the length of stay, and unnecessary medications and tests could enhance pediatric patient safety initiatives and most likely result in lower treatment costs.

Bronchiolitis is a common illness of the respiratory tract caused by an infection that affects the airways or bronchioles that lead to the lungs. As these airways become inflamed, they swell and fill with mucus, making it difficult for a child to breathe. The illness affects infants and young children most often because their small airways can become blocked more easily than those of older children or adults. Bronchiolitis typically occurs during the first 2 years of life, with the peak occurrence at about 3 to 6 months of age.

Bronchiolitis is usually caused by a viral infection, most commonly respiratory syncytial virus (RSV). Most cases of bronchiolitis are mild and require no specific professional treatment. However, some infants are at risk for a more severe illness that requires hospitalization. Antibiotics have not been useful in treating bronchiolitis as it is caused by a viral infection, and antibiotics are proven ineffective against these infections.

Researchers, using data from 30 large U.S. children's hospitals and more than 17,000 patients under one year of age, set out to document variations in treatment and diagnostic approaches, lengths of stay and readmission rates; and to determine which modifiable care measures are often associated with longer lengths of stay and antibiotic usage.

Study results showed a significant variation across hospitals in average patient length of stay, and use of antibiotics and diagnostic tests, such as x-rays. For example, the use of chest x-rays varied from 38 to 89 percent across hospitals and the use of antibiotics varied from 28 to 89 percent. The use of chest x-rays was associated with an increased likelihood of prescribing antibiotics for treatment.

"Such widespread differences in treatment, length of stay and patient outcomes indicates that we need to develop national guidelines and controlled trials of new therapies and management approaches," said Dimitri Christakis, MD, MPH, a pediatric researcher at Children's Hospital and Regional Medical Center in Seattle, director of the Child Health Institute, associate professor at the University of Washington School of Medicine and lead author of the study. "Such guidelines could have a significant impact on patient safety and help to reduce healthcare costs for unnecessary or ineffective treatments of bronchiolitis."

This national study also recommended further examination of virologic testing, to identify viral infections, as a method to decrease antibiotic use in the treatment of bronchiolitis thereby reducing costs associated with such treatment.

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