Management of Bronchiolitis in the Emergency Department

Impact of Evidence-Based Guidelines?

No significant changes were seen in management of bronchiolitis after guidelines recommended against medications and x-rays for infants and toddlers.

Bronchiolitis is one of the most common conditions for which infants and toddlers are seen in the hospital emergency department. In 2006, the American Academy of Pediatrics published evidence-based bronchiolitis guidelines. The guidelines recommend against the use of bronchodilators, corticosteroids, antibiotics, and diagnostic testing such as chest X-rays; and instead emphasize supportive care with oxygen and supplemental hydration, if necessary.

To determine if the guidelines had any effect on resource utilization, these researchers analyzed data from before and after the guidelines were published using the 2001–2009 National Hospital Ambulatory Medical Survey.

The patients were more often male (59%) and under one year of age (79%). Before and after the guidelines, bronchodilators were used in 54 percent of patient visits. Systemic steroids were used in 20 percent of visits and antibiotics were given in 33 percent. Use of chest X-rays, however, did decrease after the guidelines were issued (65% before versus 49% after). Patients seen in child-focused emergency departments were less likely to receive antibiotics but more likely to receive bronchodilators.

The findings show that practice patterns are not consistent with recommended guidelines and highlight how difficult it can be to bring about change in clinical practice.

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