Assessing Clinical Outcomes of the 2014 American Academy of Pediatrics Bronchiolitis Guideline
McDade, Patricia Alison
Pediatric bronchiolitis is an acute, highly-communicable, viral-mediated lower respiratory tract illness of early childhood. As the most common lower respiratory illness in infants, bronchiolitis represents the leading cause of infant hospitalizations worldwide (McNaughten, Hart, & Shields, 2017). Considerable controversies persist for clinicians who care for these children resulting in practice variation. Bronchiolitis places a considerable demand on healthcare resources, including $1.73 billion dollars for US hospitalizations from 2000-2009 (Hasegawa, Tsugawa, Brown, Mansbach, & Camargo, 2013), 238 outpatient visits, 71 hospitalizations, and 77 emergency department (ED) visits per 1000 infant years (Carroll et al., 2008). In 2014, the American Academy of Pediatrics published a clinical practice guideline (Ralston et al. 2014) which proposed substantial changes, including recommendations against routine use of inhaled bronchodilators or oral steroids. Following publication, there has been limited research examining the clinical and financial outcomes for children treated for bronchiolitis in the outpatient setting.A descriptive, retrospective cohort analysis was done to indirectly examine the effects of clinician adherence to the 2014 AAP Guideline by examining the comparative effectiveness of the use of albuterol, oral steroids, symptomatic home management, and/or complementary therapies for children who had clinically diagnosed bronchiolitis and who were treated in the outpatient setting. Comparative effectiveness was ascertained by the analysis of relevant clinical outcomes data from the year prior to the publication of the 2014 Guideline and for four years after. Outcome variables in the outpatient setting were compared to determine clinical effectiveness of the use of albuterol, oral steroids, symptomatic home management, and complementary therapies for the treatment of pediatric bronchiolitis. There was no statistically significant difference in ED, urgent care visits, or numbers of hospitalizations for children treated with albuterol... There was a statistically significant increase in outpatient visits in the group who had been treated with albuterol, which may be reflective of either the severity of the bronchiolitis illness or the increased vigilance of the clinician following the prescribing of albuterol. The use of an oral steroid was associated with higher hospitalization rate in this study but this data is likely confounded by the small sample size.
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