Marked Variability Observed in Inpatient Management of Bronchiolitis in a tertiarycenter. Can we do better?

Background: Bronchiolitis is the most common reason for hospitalization of children. Infants hospitalized for bronchiolitis undergo examinations and treatments not supported by current research evidence. Aim: To assess practice variations about the management of children hospitalized for bronchiolitis under the age of two. Methods: This retrospective study was conducted in a pediatric unit in a university hospital. Hospital medical records were reviewed to collect data on clinical course, testing and treatment. Data were analyzed separately for children meeting our strict definition of bronchiolitis, aged under 12 months without a history of wheezing, and a loose definition, aged 12-23 months or with a history of wheezing. Results: The median age of the 263 children was 8.8 months. Clinical management varied when stratified by strict and loose bronchiolitis subgroup definitions: complete blood counts and chest x-ray was performed in all patients, mean length of hospitalization (4.5 vs 4.4 days), intravenous fluids (97% vs 88%), oxygen supplementation (79% vs. 67%), use of salbutamol (21% vs 65%) and use of iv corticosteroids (21% vs 55%). Conclusion: The clinical management of bronchiolitis varied considerably about the two definitions of bronchiolitis. A stronger commitment to evidence-based bronchiolitis guidelines is needed.