Factors associated with nonadherence to the American Academy of Pediatrics 2014 bronchiolitis guidelines: A retrospective study.
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...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2023-01-01
|
| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0285626 |
| _version_ | 1797802079809437696 |
|---|---|
| author | Laure F Pittet Alban Glangetas Constance Barazzone-Argiroffo Alain Gervaix Klara M Posfay-Barbe Annick Galetto-Lacour Fabiola Stollar |
| author_facet | Laure F Pittet Alban Glangetas Constance Barazzone-Argiroffo Alain Gervaix Klara M Posfay-Barbe Annick Galetto-Lacour Fabiola Stollar |
| author_sort | Laure F Pittet |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-13T05:00:16Z |
| format | Article |
| id | doaj.art-fcf1c56d4df7471f93ccb6dca5e2b8a3 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-03-13T05:00:16Z |
| publishDate | 2023-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-fcf1c56d4df7471f93ccb6dca5e2b8a32023-06-17T05:31:19ZengPublic Library of Science (PLoS)PLoS ONE1932-62032023-01-01185e028562610.1371/journal.pone.0285626Factors associated with nonadherence to the American Academy of Pediatrics 2014 bronchiolitis guidelines: A retrospective study.Laure F PittetAlban GlangetasConstance Barazzone-ArgiroffoAlain GervaixKlara M Posfay-BarbeAnnick Galetto-LacourFabiola StollarThe 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.https://doi.org/10.1371/journal.pone.0285626 |
| spellingShingle | Laure F Pittet Alban Glangetas Constance Barazzone-Argiroffo Alain Gervaix Klara M Posfay-Barbe Annick Galetto-Lacour Fabiola Stollar Factors associated with nonadherence to the American Academy of Pediatrics 2014 bronchiolitis guidelines: A retrospective study. PLoS ONE |
| title | Factors associated with nonadherence to the American Academy of Pediatrics 2014 bronchiolitis guidelines: A retrospective study. |
| title_full | Factors associated with nonadherence to the American Academy of Pediatrics 2014 bronchiolitis guidelines: A retrospective study. |
| title_fullStr | Factors associated with nonadherence to the American Academy of Pediatrics 2014 bronchiolitis guidelines: A retrospective study. |
| title_full_unstemmed | Factors associated with nonadherence to the American Academy of Pediatrics 2014 bronchiolitis guidelines: A retrospective study. |
| title_short | Factors associated with nonadherence to the American Academy of Pediatrics 2014 bronchiolitis guidelines: A retrospective study. |
| title_sort | factors associated with nonadherence to the american academy of pediatrics 2014 bronchiolitis guidelines a retrospective study |
| url | https://doi.org/10.1371/journal.pone.0285626 |
| work_keys_str_mv | AT laurefpittet factorsassociatedwithnonadherencetotheamericanacademyofpediatrics2014bronchiolitisguidelinesaretrospectivestudy AT albanglangetas factorsassociatedwithnonadherencetotheamericanacademyofpediatrics2014bronchiolitisguidelinesaretrospectivestudy AT constancebarazzoneargiroffo factorsassociatedwithnonadherencetotheamericanacademyofpediatrics2014bronchiolitisguidelinesaretrospectivestudy AT alaingervaix factorsassociatedwithnonadherencetotheamericanacademyofpediatrics2014bronchiolitisguidelinesaretrospectivestudy AT klaramposfaybarbe factorsassociatedwithnonadherencetotheamericanacademyofpediatrics2014bronchiolitisguidelinesaretrospectivestudy AT annickgalettolacour factorsassociatedwithnonadherencetotheamericanacademyofpediatrics2014bronchiolitisguidelinesaretrospectivestudy AT fabiolastollar factorsassociatedwithnonadherencetotheamericanacademyofpediatrics2014bronchiolitisguidelinesaretrospectivestudy |