Secondary Outcomes: Emergency department and inpatient ward management (medication use, investigations and discharge medications).Primary Outcome: Patient disposition (admission, discharge and transfer to other hospitals).Population: Children aged less than 12 months of age treated in community emergency departments or inpatient wards with a discharge diagnosis of bronchiolitis.Management of Bronchiolitis in Community Hospitals in Ontario: a Multicentre Cohort Study. Since a number of these infants are seen in community hospital settings, the practice patterns of physicians in these environments needs further illumination.Ĭlinical Question: How is bronchiolitis managed in community hospitals?
Plint et al, in 2004, found that Canadian pediatric emergency departments continued to use bronchodilators and steroids for children with bronchiolitis. Sadly, despite multiple guidelines ( NICE, AAP, CPS), there has also been no “ magic bullet” in terms of treatment.Īlthough there has been some benefit shown with inhaled hypertonic saline ( Zhang et al 2015) and early research on combining nebulized epinephrine and systemic steroids is promising, there is concern about the ongoing use of unproven therapies such as beta-agonists, steroids alone and antibiotics.Įxisting research has helped to quantify the bronchiolitis practice patterns of physicians in children’s hospitals. Since bronchiolitis is a clinical diagnosis, there is no test, including viral testing and radiography, which rules it in or out ( Schuh et al 2007). We know that bronchiolitis presents a significant burden of disease not only to patients and families, but the health-care system as well.Īlthough the vast majority of infants with bronchiolitis can be managed with supportive care at home, due to its high incidence, it is the number one reason for infants to be hospitalized ( Njoo et al 2001, Langley et al 2003, Craig et al 2007 and Shay et al 1999). The remainder of her exam is reassuring.īackground: It has been said that there are two seasons in North America… Bronchiolitis season and August. Her cardiac exam is unremarkable, but there is diffuse wheezing throughout the lungs bilaterally, which the parents say has never happened before. She has a lot of clear nasal discharge and mildly increased work of breathing, with subcostal indrawing. You even manage to get a blood pressure, which is 78/48. On exam she is febrile at 38.4 Celsius, pulse 150bpm, respiratory rate 50bpm, and an oxygen saturation of 93% on room air. There is no family history of atopy or asthma. She is otherwise healthy, having had a previously uncomplicated prenatal, delivery, and post-natal course. She has had a cough, fever, and “noisy breathing” for the past 24 hours. Chris also has his own #FOAMed blog called Standing on the Corner Minding My Own Business ( SOCMOB).Ĭase: Parents present to your community emergency department with their 6-month-old daughter.
He is currently the host of CAEP Casts, which highlights educational innovations from emergency medicine residency programs across Canada. Chris is an emergency physician and clinical lecturer at the University of Calgary.
0 kommentar(er)
