en
Scientific article
Open access
English

Factors associated with nonadherence to the American Academy of Pediatrics 2014 bronchiolitis guidelines : A retrospective study

Published inPloS one, vol. 18, no. 5, e0285626
Publication date2023
First online date2023-05-18
Abstract

The latest guideline from the American Academy of Pediatrics for the management of bronchiolitis has helped reduce unnecessary interventions and costs. However, data on patients still receiving interventions are missing. In patients with acute bronchiolitis whose management was assessed and compared with current achievable benchmarks of care, we aimed to identify factors associated with nonadherence to guideline recommendations. In this single-centre retrospective study the management of bronchiolitis pre-guideline (Period 1: 2010 to 2012) was compared with two periods post-guideline (Period 2: 2015 to 2016, early post-guideline; and Period 3: 2017 to 2018, late post-guideline) in otherwise healthy infants aged less than 1 year presenting at the Children's University Hospitals of Geneva (Switzerland). Post-guideline, bronchodilators were more frequently administered to older (>6 months; OR 25.8, 95%CI 12.6-52.6), and atopic (OR 3.5, 95%CI 1.5-7.5) children with wheezing (OR 5.4, 95%CI 3.3-8.7). Oral corticosteroids were prescribed more frequently to older (>6 months; OR 5.2, 95%CI 1.4-18.7) infants with wheezing (OR 4.9, 95% CI 1.3-17.8). Antibiotics and chest X-ray were more frequently prescribed to children admitted to the intensive care unit (antibiotics: OR 4.2, 95%CI 1.3-13.5; chest X-ray: OR 19.4, 95%CI 7.4-50.6). Latest prescription rates were all below the achievable benchmarks of care. In summary, following the latest American Academy of Pediatrics guideline, older, atopic children with wheezing and infants admitted to the intensive care unit were more likely to receive nonevidence-based interventions during an episode of bronchiolitis. These patient profiles are generally excluded from bronchiolitis trials, and therefore not specifically covered by the current guideline. Further research should focus on the benefit of bronchiolitis interventions in these particular populations.

eng
Keywords
  • Infant
  • Humans
  • Child
  • United States
  • Retrospective Studies
  • Respiratory Sounds
  • Guideline Adherence
  • Bronchiolitis / drug therapy
  • Anti-Bacterial Agents / therapeutic use
  • Bronchodilator Agents / therapeutic use
Citation (ISO format)
PITTET, Laure et al. Factors associated with nonadherence to the American Academy of Pediatrics 2014 bronchiolitis guidelines : A retrospective study. In: PloS one, 2023, vol. 18, n° 5, p. e0285626. doi: 10.1371/journal.pone.0285626
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Identifiers
ISSN of the journal1932-6203
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Creation05/30/2023 11:37:25 AM
First validation11/13/2023 10:36:02 AM
Update time11/13/2023 10:36:02 AM
Status update11/13/2023 10:36:02 AM
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