[Management of acute bronchiolitis in spanish emergency wards: variability and appropriateness analysis (aBREVIADo project)]

Abstract

Introduction: The management of acute bronchiolitis (AB) is controversial. The aim of this multicenter nationwide study in Spain is to determine the variability in the management of AB in Primary Care centers.

Methods: A cross-sectional observational study (from October 2007 to March 2008) was conducted on all cases of AB (McConnochie criteria) seen in a sample of 60 Health Care Centers from 11 regions of Spain, who did not require hospital admission. A comparison between autonomous communities was made.

Results: A total of 940 cases were collected. It was found that there was a low use of diagnostic tests, although with significant differences between communities. There was an excessive use of inhaled (64.1%) or oral (17.8%) beta 2-adrenergics, and to a lesser degree of corticosteroids (25%) and other treatments of unclear efficacy (antibiotics, bronchodilators, oral, inhaled corticosteroids, ipratropium bromide, etc...). The treatment methods in the different communities varied significantly. In the acute phase there was an inappropriate use of treatments in 74.8% of cases, and in 47.4% in the maintenance phase.

Conclusions: There are discrepancies between routine practice and evidence-based management of outpatient AB, due to a wide use of inappropriate treatments. The variability in the prescription of bronchodilators or steroids between communities shows the lack of justification and there is scope for improvement.

Keywords: Atención primaria; Bronquiolitis vírica/diagnóstico; Bronquiolitis vírica/tratamiento; Infants; Lactantes; Primary care; Viral bronchiolitis/diagnosis; Viral bronchiolitis/treatment.

Copyright © 2012 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.