[Consensus conference on acute bronchiolitis (v): prevention of acute bronchiolitis. Review of scientific evidence]

Management of acute bronchiolitis in emergency wards in Spain: variability and appropriateness analysis (aBREVIADo Project)

Most patients with acute bronchiolitis have a mild course and only require outpatient care. However, some of them have to go to emergency departments, because they have respiratory distress or feeding problems. There, they frequently receive diagnostic and therapeutic procedures. We want to know the variability and appropriateness of these procedures. A cross-sectional study (October 2007 to March 2008) was carried out on 2,430 diagnosed cases of bronchiolitis in hospital emergency departments, which required no hospitalization. An analysis of the appropriateness of the treatments was made in 2,032 cases gathered in ten departments with at least 100 cases, using as criterion the recommendations of a consensus conference. We estimated the adjusted percentages of each department. Most of the bronchiolitis were mild, in spite that they underwent multiple diagnostic and therapeutic procedures. In the acute phase, different treatments were used: inhaled beta 2 agonists (61.4%), antipyretics (17.1%), oral steroids (11.3%), and nebulized adrenaline (9.3%). In the maintenance phase, the most common treatments were: inhaled beta 2 agonists (50.5%), oral steroids (17%), oral beta 2 agonists (14.9%), and antibiotics (6.1%). The 64% of the treatments used in the acute phase and the 55.9% in the maintenance phase were considered inappropriate in the appropriateness analysis; a great heterogeneity among centers was found.

CONCLUSIONS

There are discrepancies between clinical practice and evidence-based management of bronchiolitis in Spanish emergency departments. Inappropriate treatments were used in more than half of patients. The wide variation between centers shows the influence of local prescribing habits and reveals the scope for improvement.

[Aetiology of bronchiolitis in hospitalised children in South-East Spain]

Introducción

La bronquiolitis es una de las infecciones respiratorias más comunes en niños menores de 2 años y una de las principales causas de ingreso en niños pequeños, especialmente durante el invierno.

Objetivos

Determinar la prevalencia y etiología de bronquiolitis en el sureste de España.

Material y métodos

Se realizó un estudio prospectivo durante la temporada de bronquiolitis (diciembre-abril). En el estudio se incluyeron niños menores de 18 meses ingresados en el hospital con motivo del primer episodio de bronquiolitis. Se analizaron aspirados nasofaríngeos mediante una técnica de reacción en cadena de la polimerasa (múltiple), precedida de transcripción inversa del ARN viral (RT-PCR).

Resultados

Se incluyeron en el estudio 235 niños, de cada uno de los cuales se obtuvo una muestra de aspirado nasofaríngeo. Se detectaron virus respiratorios en muestras de 204 niños (en total 287 virus). El virus respiratorio sincitial se detectó con mayor frecuencia seguido del rinovirus. Se observaron infecciones virales mixtas en el 36% de los niños en los que se detectó algún virus respiratorio. La asociación más frecuente fue el virus respiratorio sincitial A con rinovirus.

Conclusiones

Se detectaron virus respiratorios en la mayoría de los niños menores de 18 meses hospitalizados por bronquiolitis, en forma de infección mixta en el 36% de aquellos con infección viral.