1. Rosenberg, Karen


According to this study:


* Targeted interventions improved the treatment of infants with bronchiolitis by reducing the use of non-evidence-based therapies without any identified negative consequences.



Article Content

Despite guidelines recommending supportive respiratory and hydration care for infants who have bronchiolitis, gaps exist between evidence-based and clinical practice, with many infants receiving low-value care. A cluster randomized clinical trial was designed to determine the effectiveness of targeted interventions compared with passive dissemination of a clinical guideline to improve the evidence-based treatment of infants who present with bronchiolitis at the hospital.


Hospitals were eligible for inclusion in the study if they had more than 135 bronchiolitis cases per year. The study included 26 hospitals in Australia and New Zealand. Intervention hospitals received interventions that were developed using behavior change theories and targeted nurses and medical clinicians who managed infants with bronchiolitis in the ED and pediatric inpatient treatment units. Control hospitals received electronic and printed copies of the Australasian Bronchiolitis Guideline.


The hospitals included in the study treated 8,003 infants during bronchiolitis season in the three years before the intervention year and 3,727 infants during the intervention bronchiolitis season. During the first 24 hours of a hospitalization, compliance with the guideline recommendations (that is, no use of chest radiography, albuterol, glucocorticoids, antibiotics, or epinephrine) occurred in 1,631 infants (85.1%) in the intervention group compared with 1,321 infants (73%) in the control group.


In the intervention hospitals, compliance improved for patients in the ED, as inpatients, and during the total hospitalization. Improvements occurred for each of the five guideline recommendations, with strong evidence for improvement in the use of albuterol and chest radiography.


Improvements in evidence-based management and reductions in low-value, potentially harmful treatment were achieved without increasing lengths of stay or the number of ICU admissions.


The researchers note that translating these results to smaller or resource-limited hospitals should be undertaken with caution. They also point out that data collection was retrospective and information bias as the result of missing data was possible. Moreover, no hospital was 100% compliant with all intervention protocols.


Haskell L, et al JAMA Pediatr 2021;175(8):797-806.