AAP Guidance Tied to Less Intensive Bronchiolitis Management

Diedtra Henderson

December 02, 2013

The use of chest radiography, steroids, and bronchodilators for infants and toddlers with bronchiolitis decreased significantly after the American Academy of Pediatrics (AAP) published evidence-based clinical practice guidelines in 2006, according to a retrospective, observational cohort study.

Kavita Parikh, MD, a pediatric hospitalist in the Division of Hospitalist Medicine at Children's National Medical Center in Washington, DC, and colleagues published their results online December 2 in Pediatrics.

According to the National Institutes of Health, infants are often hospitalized during the winter and early spring with bronchiolitis, a respiratory ailment. Bronchiolitis accounts for $543 million in annual hospitalization charges, the authors note.

The AAP guidelines endorsed supportive care with oxygen and, when needed, hydration, and they counseled against diagnostic testing and medications unsupported by scientific evidence. To gauge the guidelines' impact, the researchers analyzed administrative billing data from 130,262 patients aged 1 to 24 months who were first admitted for bronchiolitis from November 1, 2004, to March 31, 2012, at 41 pediatric hospitals that contribute data to the Pediatric Health Information System.

The use of diagnostic chest radiography, corticosteroids, and bronchodilators (P < .0001) decreased significantly. Antibiotic use also trended downward, but the magnitude of the change did not achieve statistical significance.

"For hospitalized patients with bronchiolitis aged 1 to 24 months, we show a temporal association between publication of the 2006 AAP bronchiolitis guidelines and a decrease in resource use, including both diagnostic tests (CBC [complete blood cell] count and CXR [chest radiography]) and therapies (corticosteroids and bronchodilators)," the authors write. "Although we cannot demonstrate a causal relationship, this reduction of diagnostic testing and treatment resources for bronchiolitis after guideline publication is striking and may be reducing costs associated with this common respiratory illness."

Among the limitations of the study, the administrative and billing database used by the researchers did not include detailed clinical information, and the team relied on diagnosis and procedure codes to select patients. In addition, the database does not include community hospitals, which treat more than 70% of infants and toddlers with bronchiolitis.

"The AAP's publication of its 2006 evidence-based guidelines for bronchiolitis was associated with a reduction of non–evidence-based diagnostic testing and medication use for inpatients in a representative sample of children's hospitals. These trends may demonstrate a benefit of nationally developed guidelines to reduce variations in care and unnecessary costs," Dr. Parikh and coauthors conclude.

One study author disclosed receiving funding from the Academic Pediatric Association. The remaining authors have disclosed no relevant financial relationships.

Pediatrics. Published online December 2, 2013. Abstract