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Variations in bronchiolitis management between five New Zealand hospitals: Can we do better?

2003; Wiley; Volume: 39; Issue: 1 Linguagem: Inglês

10.1046/j.1440-1754.2003.00069.x

1440-1754

AM Vogel, DR Lennon, Jane E. Harding, RE Pinnock, DA Graham, Keith Grimwood, Philip Pattemore,

Transplantation: Methods and Outcomes

To determine the current management of bronchiolitis by five major New Zealand hospitals and to identify areas for improvement.Lists of infants under 1 year of age admitted with bronchiolitis during 1998 were obtained from the casemix offices of the five largest New Zealand hospitals with paediatric services. Hospital records from a random sample of these admissions were reviewed.Out of the 409 infants admitted overnight, 8% had been born less than or=32 weeks gestation and 53% were aged younger than 6 months. Overall, 59% received oxygen, 21% had nasogastric fluids, 22% had intravenous fluids, 34% were prescribed antibiotics, 42% received bronchodilators and 60% had a chest radiograph. Respiratory secretions were collected for viral studies from 58% of infants and, in 59%, respiratory syncytial virus was detected. Significant variations in management were detected between hospitals. The overall proportion of infants requiring oxygen, intravenous or nasogastric fluids (65%) was significantly higher than that found in a 1986-1988 Christchurch study where only 25% received one or more of these interventions (P < 0.001).Opportunities exist to rationalize bronchiolitis management in New Zealand with potential cost savings, particularly by reducing the number of chest radiographs and prescribing of unnecessary antibiotics and bronchodilators.