Bronchiolitis is one of the most common conditions for which infants and young children are evaluated in the emergency department (ED). Recent practice guidelines from the American Academy of Pediatrics recommend limiting the use of bronchodilators, steroids, and diagnostic testing for patients with bronchiolitis. We sought to determine the association of the publication of national guidelines with bronchiolitis care and practices in the ED.
We analyzed data from the National Hospital Ambulatory Medical Survey emergency department component, a nationally representative 4‐stage probability sample of ED visits. For all patients with bronchiolitis, we generated descriptive statistics regarding medication and imaging utilization and bivariate analyses to compare utilization for patient visits before and after the introduction of the guidelines. We used logistic regression to determine the independent association of the availability of the guidelines aspects of care. All analyses were completed using SUDAAN.
There were approximately 220 million ED visits by pediatric patients during the 8‐year study. Approximately 1.9 million patients under 2 years of age were diagnosed with bronchiolitis, representing about 0.90% of the total ED visits by pediatric patients and 3.6% of ED visits for patients younger than 2 years. Bronchodilators were prescribed in 52.7% of patient visits, with no differences noted after the introduction of the guidelines (53.0% vs. 51.7%, P = 0.85). Systemic steroids were used in 20.0% of patient visits with no differences noted after the introduction of the guidelines (21.9% vs. 14.7%, P = 0.12). Chest x‐rays were utilized significantly less frequently after the introduction of the guidelines (65.3% vs. 51.9%, P = 0.04). After adjusting for patient and hospital characteristics, patients seen after the introduction of the guidelines had significantly reduced odds of having radiographs obtained (adjusted odds ratio, 0.45; 95% CI, 0.28–0.73).
For patients with bronchiolitis seen in the ED, utilization of medications remains similar to rates seen in the previous decade, although utilization of radiographs has decreased over the study period. Publication of evidence‐based guidelines has not had a significant impact on ED management of bronch‐iolitis in this nationally representative sample.
L. Johnson ‐ none; J. Robles ‐ none; A. Hudgins ‐ none; S. Madrid ‐ none; D. Martin ‐ none; A. Thompson ‐ none