Nm. Kini et al., Inpatient care for uncomplicated bronchiolitis - Comparison with Milliman and Robertson guidelines, ARCH PED AD, 155(12), 2001, pp. 1323-1327
Context: Bronchiolitis is the most common lower respiratory tract infection
in infancy. A recent Centers for Disease Control and Prevention report con
firmed that hospitalization rates for bronchiolitis have increased 2.4-fold
from 1980 to 1996. Controversies exist about optimal treatment plans. Mill
iman and Robertson recommend ambulatory care management; in case of hospita
lization, the recommended length of stay is 1 day.
Objectives: To relate actual practice variation for infants admitted with u
ncomplicated bronchiolitis to Milliman and Robertson's recommendations.
Design: Prospective observational study.
Setting: General care wards of 8 pediatric hospitals of the Child Health Ac
countability Initiative during the winter of 1998-1999.
Patients: First-tine admissions for uncomplicated bronchiolitis in patients
not previously diagnosed as having asthma and who were younger than 1 year
.
Main Outcome Measures: Respiratory rate, monitored interventions, attainmen
t of discharge criteria goals, and length of stay.
Results: Eight hundred forty-six patients were included in the final analys
is: 85.7% were younger than 6 months, 48.5% were nonwhite, and 64.1% were M
edicaid recipients or self-pay. On admission to the hospital, 18.3% of the
infants had respiratory rates higher than higher than 80 breaths per minute
, 53.8% received supplemental oxygen therapy, and 52.6% received intravenou
s fluids. These proportions decreased to 1.9%, 33.8%, and 20.3%, respective
ly, 1 day after admission, and to 0.7%, 20.1%, and 8.6%, respectively, 2 da
ys after admission. The average length of stay was 2.8 days (SD, 2.3 days).
Conclusions: Milliman and Robertson's recommendations do not correspond to
practice patterns observed at the hospitals participating in this study; no
hospital met the Milliman and Robertson recommended 1-day goal length of s
tay. Administration of monitored intervention persisted past the second day
of hospitalization.