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Variations in bronchiolitis management between five New Zealand hospitals: Can we do better?
Author(s) -
Vogel AM,
Len DR,
Harding JE,
Pinnock RE,
Graham DA,
Grimwood K,
Pattemore PK
Publication year - 2003
Publication title -
journal of paediatrics and child health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.631
H-Index - 76
eISSN - 1440-1754
pISSN - 1034-4810
DOI - 10.1046/j.1440-1754.2003.00069.x
Subject(s) - medicine , bronchiolitis , intensive care medicine , emergency medicine , pediatrics , respiratory system
Objectives: To determine the current management of bronchiolitis by five major New Zealand hospitals and to identify areas for improvement. Methods: 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. Results: Out of the 409 infants admitted overnight, 8% had been born ≤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). Conclusions: 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.