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Andina Martínez D, Calderón Checa RM, Ferrero García Loygorri C, Arnaiz Diumenjo Y, Porto Abal R, Muñoz López C, Barrios Tascon A, Rodríguez Mesa M, Bautista Lozano D, Lagares Velasco A, Hernández Rupérez MB, Escobar Pirela HD, Sánchez Calderón A, Casado Verrier E, Rivas Crespo C, Prieto Martínez S, Ruiz González S, Joyanes Abancens B, Baro Huarte MG, García Herrero MÁ, Villares Alonso R, Stanescu S, Moreno Sánchez R, Gallego Fernández CS, De la Torre Espi M. Improving emergency department care of infants with acute bronchiolitis by reducing the use of unrecommended drugs: a quality-of-care initiativem in a Spanish autonomous community. Emergencias 2023; 35:31-38. [PMID: 36756914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
OBJECTIVES To evaluate the impact of a quality-of-care improvement program implemented in emergency departments (EDs) in a Spanish autonomous community with the aim of reducing the use of unrecommended drugs when treating infants for acute bronchiolitis. MATERIAL AND METHODS Before-after quasi-experimental intervention study. We retrospectively included infants aged 12 months or less who were treated for acute bronchiolitis in 24 Spanish national health system hospital EDs in December during 2 epidemic periods: in 2018, before implementing the program, and in 2019, after implementation. Data collected included epidemiologic information, clinical and care details, and clinical course. The program consisted of providing informative material and training sessions before the epidemic period started. RESULTS A total of 7717 episodes (4007 in 2018 and 2710 in 2019) were identified. Epidemiologic and clinical characteristics did not differ between the 2 periods. ED use of the following treatments decreased between the 2 periods: salbutamol, from 29.4% (95% CI, 28.8%-30.8%) in 2018 to 10.6% (95% CI, 9.6%-11.6%) in 2019; epinephrine from 6.0% (95% CI, 5.3%-6.8%) to 0.9% (95% CI, 0.7%-1.3%); and hypertonic saline solution fell from 8.2% (95% CI, 7.3%-9.1%) to 2.1% (95% CI, 1.7%-2.6%) (P.001, all comparisons). Prescriptions for salbutamol on discharge fell from 38.7% (95% CI, 36.9%-40.4%) to 10.6% (95% CI, 9.6%-11.6%) (P.001). Admissions and readmissions did not change, and the median time (interquartile range) spent in the ED fell from 81 (44-138) minutes to 66 (37-127) minutes (P.001). CONCLUSION The quality-of-care improvement initiative was able to decrease the number of unrecommended therapeutic interventions for acute bronchiolitis. However, we identified great variations between EDs, suggesting that training and assessment of impact should continue.
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Affiliation(s)
| | | | | | | | - Raquel Porto Abal
- Servicio de Urgencias, Hospital Universitario Puerta de Hierro, Madrid, España
| | | | - Ana Barrios Tascon
- Servicio de Urgencias, Hospital Universitario Infanta Sofía, Madrid, España
| | | | | | | | | | | | | | | | - Carlos Rivas Crespo
- Servicio de Urgencias, Hospital Universitario Fundación Alcorcón, Madrid, España
| | | | - Sara Ruiz González
- Servicio de Urgencias, Hospital Universitario Severo Ochoa, Madrid, España
| | | | | | | | | | - Sinziana Stanescu
- Servicio de Urgencias, Hospital Universitario Ramón y Cajal, Madrid, España
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Grasa CD, Fernández-Cooke E, Domínguez-Rodríguez S, Aracil-Santos J, Barrios Tascon A, Sánchez-Manubens J, Mercader B, Antón J, Nuñez E, Villalobos E, Bustillo M, Camacho M, Oltra Benavent M, Giralt G, Bello Naranjo AM, Rocandio B, Calvo C. Risk scores for Kawasaki disease, a management tool developed by the KAWA-RACE cohort. Clin Rheumatol 2022; 41:3759-3768. [PMID: 35939163 DOI: 10.1007/s10067-022-06319-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/13/2022] [Accepted: 07/26/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION/OBJECTIVES Asian scores developed to predict unresponsiveness to intravenous immunoglobulin (IVIG) or development of coronary artery aneurysms (CAA) in patients with Kawasaki disease (KD) are not appropriate in Western populations. The purpose of this study is to develop 2 scores, to predict unresponsiveness to IVIG and development of CAA, appropriate for Spanish population. METHOD Data of 625 Spanish children with KD collected retrospectively (2011-2016) were used to identify variables to develop the 2 scores of interest: unresponsiveness to IVIG and development of CAA. A statistical model selected best variables to create the scores, and scores were validated with data from 98 patients collected prospectively. RESULTS From 625 patients of the retrospective cohort, final analysis was performed in 439 subjects: 37 developed CAA, and 212 were unresponsive to IVIG. For the score to predict CAA, a cutoff ≥ 8 was considered for high risk, considering a score system with a different weight for each of the eight variables. External validation showed a sensitivity of 22% and a specificity of 75%. The score to predict unresponsiveness to IVIG established a cutoff ≥ 8 for high risk, considering a score system with a different weight for each of the nine variables. External validation showed a sensitivity of 78% and a specificity of 50%. CONCLUSIONS Two risk scores for KD were developed from Spanish population, to predict development of CAA and unresponsiveness to IVIG; validation in other cohorts could help to implement these tools in the management of KD in other Western populations.
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Affiliation(s)
- Carlos D Grasa
- Department of Pediatric Infectious Diseases, La Paz Children's Hospital (IdiPaz Foundation), Madrid, Spain
- IdiPaz, Institute for Health Research from La Paz Hospital, Madrid, Spain
- CIBERINFEC, CIBER of Infectious Diseases in Spain (Instituto de Salud Carlos III - ISCIII), Seville, Spain
| | - Elisa Fernández-Cooke
- Pediatric Infectious Diseases Unit, Pediatric Research and Clinical Trial Unit (UPIC), Department of Pediatrics, Hospital Universitario 12 Octubre, Avda. Córdoba s/n., 28041, Madrid, Spain.
- imas12, Instituto de Investigación Sanitaria Hospital 12 de Octubre, Madrid, Spain.
- RITIP, Spanish Network for the Research in Pediatric Infectious Diseases, Madrid, Spain.
| | - Sara Domínguez-Rodríguez
- Pediatric Infectious Diseases Unit, Pediatric Research and Clinical Trial Unit (UPIC), Department of Pediatrics, Hospital Universitario 12 Octubre, Avda. Córdoba s/n., 28041, Madrid, Spain
- imas12, Instituto de Investigación Sanitaria Hospital 12 de Octubre, Madrid, Spain
| | - Javier Aracil-Santos
- Department of Pediatric Infectious Diseases, La Paz Children's Hospital (IdiPaz Foundation), Madrid, Spain
| | - Ana Barrios Tascon
- Department of Pediatrics, Hospital Universitario Infanta Sofia, San Sebastian de los Reyes, Madrid, Spain
| | - Judith Sánchez-Manubens
- Department of Pediatric Rheumatology, Hospital Sant Joan de Deu, Universitat de Barcelona, Barcelona, Spain
- Department of Pediatric Rheumatology, Hospital Parc Tauli, Sabadell, Spain
| | - Beatriz Mercader
- Department of Pediatrics, Hospital Virgen de la Arrixaca, Murcia, Spain
| | - Jordi Antón
- Department of Pediatric Rheumatology, Hospital Sant Joan de Deu, Universitat de Barcelona, Barcelona, Spain
| | - Esmeralda Nuñez
- Pediatric Rheumatology Unit, Department of Pediatrics, Hospital Regional Universitario, Malaga, Spain
| | | | - Matilde Bustillo
- Department of Pediatric Infectious Diseases, Hospital Miguel Servet, Zaragoza, Spain
| | - Marisol Camacho
- Pediatric Infectious Diseases, Rheumatology and Immunology Unit, Department of Pediatrics, Hospital Virgen del Rocio, Sevilla, Spain
| | - Manuel Oltra Benavent
- Department of Pediatrics, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Gemma Giralt
- Department of Pediatric Cardiology, Hospital Vall d'Hebron, Barcelona, Spain
| | - Ana Maria Bello Naranjo
- Department of Pediatrics, Hospital Universitario Materno-Infantil de Las Palmas de Gran Canaria, Canarias, Spain
| | - Beatriz Rocandio
- Department of Pediatrics, Hospital Universitario Donostia, San Sebastian, Spain
| | - Cristina Calvo
- Department of Pediatric Infectious Diseases, La Paz Children's Hospital (IdiPaz Foundation), Madrid, Spain
- IdiPaz, Institute for Health Research from La Paz Hospital, Madrid, Spain
- CIBERINFEC, CIBER of Infectious Diseases in Spain (Instituto de Salud Carlos III - ISCIII), Seville, Spain
- RITIP, Spanish Network for the Research in Pediatric Infectious Diseases, Madrid, Spain
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