Article: | MedLuna.com

Overview

Journal Tijdschr Kindergeneeskd

Specialty Pediatrics

Date 2020 Mar 29

PMID 32218640

Authors

B A Semmekrot

E A Croonen

G Weijers

P M V van Wieringen

R A Holl

J C M Hendriks

G P J M Gerrits

Affiliations

Soon will be listed here.

Abstract

Purpose: Evaluating the guideline 'Diagnosis and treatment of respiratory syncytial (RS) virus bronchiolitis' on the number of chest X-rays, C-reactive proteïn (CRP) counts, leukocyte counts, and antibiotic prescriptions in infants admitted to hospital with RS bronchiolitis.

Design: Retrospective 'before-after' cohort study.

Location: Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands.

Patients: Infants admitted with proven RS virus infection.

Methods: Guidelines, including sound restriction of performance of X-rays, CRP and leukocytes, were introduced in February 2003. Data from infants admitted with RS virus infection during 1997- 1999 (cohort A) were compared with those admitted from 2003- April 2006 (cohort B)Results: There were 155 infants in cohort A and 170 in cohort B. Implementation of guidelines led to significant reductions of CRP and leukocyte determinations: 49.0% and 48.2%, respectively (both p<0.001) and X-rays: 30.3% (p=0.020). Numbers of antibiotic prescriptions decreased with 55% (p<0.001). The chance of antibiotic prescription increased significantly when X-rays (OR=5.2), CRP (OR=5.4), or leukocytes (OR=4.2) were done. After implementation of the guidelines, the median stay in hospital decreased significantly from 8.0 to 6.0 days (p<0.001; ranges 1-13 days and 2-23 days, respectively). Performing X-ray, CRP or leukocytes, or antibiotic prescription did not significantly alter the total duration of hospital stay.

Conclusion: Implementation of the guidelines led to significant decreases in numbers of X-rays, CRP and leukocytes determinations, and antibiotic prescriptions. Our data support the restrictive use of chest X-rays, CRP and leukocyte determinations in infants, admitted to hospital with RS virus bronchiolitis.

References

Levine D, Platt S, Dayan P, Macias C, Zorc J, Krief W . Risk of serious bacterial infection in young febrile infants with respiratory syncytial virus infections. Pediatrics. 2004; 113(6):1728-34. DOI: 10.1542/peds.113.6.1728. View

Perlstein P, Kotagal U, Schoettker P, Atherton H, Farrell M, Gerhardt W . Sustaining the implementation of an evidence-based guideline for bronchiolitis. Arch Pediatr Adolesc Med. 2000; 154(10):1001-7. DOI: 10.1001/archpedi.154.10.1001. View

Swingler G, Hussey G, Zwarenstein M . Randomised controlled trial of clinical outcome after chest radiograph in ambulatory acute lower-respiratory infection in children. Lancet. 1998; 351(9100):404-8. DOI: 10.1016/S0140-6736(97)07013-X. View

Purcell K, Fergie J . Concurrent serious bacterial infections in 912 infants and children hospitalized for treatment of respiratory syncytial virus lower respiratory tract infection. Pediatr Infect Dis J. 2004; 23(3):267-9. DOI: 10.1097/01.inf.0000116759.21252.29. View

Nagayama Y, Tsubaki T, Nakayama S, Sawada K, Taguchi K, Tateno N . Gender analysis in acute bronchiolitis due to respiratory syncytial virus. Pediatr Allergy Immunol. 2006; 17(1):29-36. DOI: 10.1111/j.1399-3038.2005.00339.x. View

Hayden F . Rhinovirus and the lower respiratory tract. Rev Med Virol. 2004; 14(1):17-31. PMC: 7169234. DOI: 10.1002/rmv.406. View

Clayton Bordley W, Viswanathan M, King V, Sutton S, Jackman A, Sterling L . Diagnosis and testing in bronchiolitis: a systematic review. Arch Pediatr Adolesc Med. 2004; 158(2):119-26. DOI: 10.1001/archpedi.158.2.119. View

Harrison A, Boeing N, Domachowske J, Piedmonte M, Kanter R . Effect of RSV bronchiolitis practice guidelines on resource utilization. Clin Pediatr (Phila). 2001; 40(9):489-95. DOI: 10.1177/000992280104000903. View

Hall C, Powell K, Schnabel K, Gala C, Pincus P . Risk of secondary bacterial infection in infants hospitalized with respiratory syncytial viral infection. J Pediatr. 1988; 113(2):266-71. View

10.

La Via W, Grant S, Stutman H, Marks M . Clinical profile of pediatric patients hospitalized with respiratory syncytial virus infection. Clin Pediatr (Phila). 1993; 32(8):450-4. DOI: 10.1177/000992289303200801. View

11.

Kotagal U, Robbins J, Kini N, Schoettker P, Atherton H, Kirschbaum M . Impact of a bronchiolitis guideline: a multisite demonstration project. Chest. 2002; 121(6):1789-97. DOI: 10.1378/chest.121.6.1789. View

12.

Smyth R, Openshaw P . Bronchiolitis. Lancet. 2006; 368(9532):312-22. DOI: 10.1016/S0140-6736(06)69077-6. View

13.

Rothbarth P, Kimpen J, Roord J, Neijens H . [Respiratory syncytial virus infections and preventive options]. Ned Tijdschr Geneeskd. 2000; 144(1):15-9. View

14.

Boezen H, Jansen D, Postma D . Sex and gender differences in lung development and their clinical significance. Clin Chest Med. 2004; 25(2):237-45. DOI: 10.1016/j.ccm.2004.01.012. View

15.

Principi N, Bosis S, Esposito S . Human metapneumovirus in paediatric patients. Clin Microbiol Infect. 2006; 12(4):301-8. PMC: 7128939. DOI: 10.1111/j.1469-0691.2005.01325.x. View

16.

Kneyber M, Brandenburg A, de Groot R, Joosten K, Rothbarth P, Ott A . Risk factors for respiratory syncytial virus associated apnoea. Eur J Pediatr. 1998; 157(4):331-5. DOI: 10.1007/s004310050822. View

17.

van Woensel J, van Aalderen W, Kimpen J . Viral lower respiratory tract infection in infants and young children. BMJ. 2003; 327(7405):36-40. PMC: 1126381. DOI: 10.1136/bmj.327.7405.36. View

18.

Behrendt C, Decker M, Burch D, Watson P . International variation in the management of infants hospitalized with respiratory syncytial virus. International RSV Study Group. Eur J Pediatr. 1998; 157(3):215-20. DOI: 10.1007/s004310050798. View

19.

Hopstaken R, Stobberingh E, Knottnerus J, Muris J, Nelemans P, Rinkens P . Clinical items not helpful in differentiating viral from bacterial lower respiratory tract infections in general practice. J Clin Epidemiol. 2005; 58(2):175-83. DOI: 10.1016/j.jclinepi.2004.08.004. View

20.

van den Hoogen B, de Jong J, Groen J, Kuiken T, de Groot R, Fouchier R . A newly discovered human pneumovirus isolated from young children with respiratory tract disease. Nat Med. 2001; 7(6):719-24. PMC: 7095854. DOI: 10.1038/89098. View