Management of Bronchiolitis in Portugal, 2000-2015: Do Guidelines Have an Impact? - EAP 2019 Congress and MasterCourse Porto Palacio Hotel

Jose Fontoura-Matias ¹ Diana Moreira-Sousa ² Alberto Freitas ^3,4 Inês Azevedo ^1,2,5

¹Centro Materno-Pediátrico, Pediatrics Department, Centro Hospitalar São João, Portugal
²Department of Obstetrics-Gynecology and Pediatrics, Faculty of Medicine, University of Porto, Portugal
³Department of Community Medicine, Information and Health Decision Sciences - MEDCIDS, Faculty of Medicine, University of Porto, Portugal
⁴Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Portugal
⁵EpiUnit, Institute of Public Health, University of Porto, Portugal

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 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 Chi-square test and logistic regression.

Results: In the 80,491 hospitalizations due to bronchiolitis, we found a high mean use rate of non-recommended diagnostic and treatmet procedures: chest x-ray (66.5%), blood analysis (56.5%) and respiratory secretions analysis (12.7%); nebulized therapy (83.5%), intravenous corticosteroids (24.2%), intravenous antibiotics (26.0%), electrolytes infusion (37.6%), and chest physiotherapy (20.4%). Over time, there was a gradual change in attitudes (Ptrend <0.001), with significant variation between regions. Centre region registered the lowest mean rates of routinely non-recommended procedures.

Conclusions: In this first national study, rates of the non-recommended diagnostic and treatment attitudes in bronchiolitis were higher than desirable, although there was a modest decrescent 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.