Management of bronchiolitis in Portugal, 2000-2015: Do guidelines have an impact?

Abstract

Background: Several studies report an excessive use of diagnostic tests and procedures in bronchiolitis, not supported by guidelines. Objectives: We aimed to evaluate medical interventions in children hospitalized with bronchiolitis in public Portuguese hospitals, from 2000 to 2015, to evaluate the impact of the national guideline, published in December 2012, and assess variations between regions. Methods: Data was collected retrospectively from an administrative database that contains all hospitalizations in mainland public hospitals. Cases were selected using the ICD-9-CM codes 466.11 (bronchiolitis due to respiratory syncytial virus) and 466.19 (bronchiolitis due to other infectious organisms), in children under 2 years of age. For statistical analysis we used the χ2 test and logistic regression. Results: In the 80 491 hospitalizations due to bronchiolitis, we found a high mean use rate of nonrecommended diagnostic and treatment procedures: chest x-ray (66.5%), blood analysis (56.5%) and respiratory secretions analysis (12.7%); nebulized therapy (83.5%), intravenous (IV) corticosteroids (24.2%), IV antibiotics (26.0%), electrolytes infusion (37.6%), and chest physiotherapy (20.4%). Over time, there was a gradual change in attitudes (Ptrend < .001), with significant variation between regions. Center region registered the lowest mean rates of routinely nonrecommended procedures. Conclusions: In this first national study, rates of the nonrecommended diagnostic and treatment attitudes in bronchiolitis were higher than desirable, although there was a modest decreasing trend in their use over time. The observed variations were mainly dependent on the region, with no clear impact of the national guideline in attitude changing, highlighting the need for more active measures.