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2017 ; 1
(1
): e000089
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Retrospective audit of guidelines for investigation and treatment of
bronchiolitis: a French perspective
#MMPMID29637125
Benhamida M
; Bihouee T
; Verstraete M
; Gras Le Guen C
; Launay E
BMJ Paediatr Open
2017[]; 1
(1
): e000089
PMID29637125
show ga
INTRODUCTION: As the most recent French bronchiolitis guidelines were published
in 2000, there is a current overinvestigation and an overtreatment of infants
hospitalised with bronchiolitis in France. In 2012, the Group of Pediatric
University Hospitals in Western France ('HUGO') proposed new evidence-based
clinical practice guidelines in keeping with the latest international guidelines.
We hypothesise that the implementation of these guidelines contributed to the
quality improvement of the management of bronchiolitis in our hospital. The aim
of this study was to determine the impact of these guidelines on the management
of bronchiolitis inpatients. METHODS: This retrospective before/after study
design was conducted in the general paediatric unit of a tertiary care French
hospital, looking at 1?year before (ie, the winter of 2011-2012) and 1?year after
(ie, the winter of 2013-2014) the implementation of the guidelines. Two hundred
and eighty bronchiolitis inpatients, all less than 1?year of age, 115 in
2011-2012 and 165 in 2013-2014, were included. The primary outcome we sought to
evaluate was the proportion of children administered a diagnostic test associated
with a treatment not routinely recommended by the guidelines. As balancing
measures, we evaluated the length of stay, the intensive care unit transfer and
the readmission rates. RESULTS: Following implementation of the guidelines, use
of any given treatment associated with a diagnostic test was reduced by 66%
(p<0.001). There were major decreases in the use of chest X-ray (86%vs26%,
p<0.001), antibiotics (38%vs13%, p<0.001) and corticosteroids (10%vs3%, p=0.011).
Balancing measures were not significantly different. CONCLUSIONS: HUGO guidelines
were effective at reducing the administration of unnecessary diagnostic tests and
medications. This study was the first step in convincing French paediatricians to
streamline their practices until updated national guidelines are published.