Introduction: Bronchiolitis is one of the most common infectious diseases of childhood and the most frequent cause of hospitalization in infants. The 2014 American Academy of Pediatrics (AAP) clinical practice guideline recommended that routine chest radiography (CXR) should not be obtained in the diagnosis of bronchiolitis, as studies have shown that they do not affect clinical outcomes, but rather lead to overuse of pharmacological agents and a longer length of hospital stay.
Objective: To determine whether active institution of bronchiolitis practice guidelines, in the Hadassah Pediatric Emergency Departments (ED) at Ein-Kerem and Mount Scopus, decreased the use of CXR. Secondary outcomes included lowering the use of unnecessary medical interventions and shortening the mean hospital length of stay.
Methods: Guidelines were reviewed with the ED staff and posted at the physician computer stations. Prospective data obtained during the study period was compared with retrospective data from the year prior to implementation of the above measures.
Results: Post-intervention patients underwent CXR via ED referral in 38 of 117 cases (32.5%) vs. 114 of 198 cases (57.6%) in the retrospective cohort (p< 0.0001). Additionally, a reduction in hospitalizations (62.4% vs. 75.8%, p= 0.0116) and a shortened average length of stay (4.057 vs. 3.355 days) were noted.
Conclusion: This simple intervention was successful in reinforcing the AAP guidelines leading to less radiation exposure, hospitalizations and a shorter average length of stay. The adherence to established clinical guidelines may promote greater cost-effectiveness, saving valuable time and resources for the hospital and the ED staff.
