Table 2. Evolution of prescriptions against benchmark reference values for acute bronchiolitis, over three periods of time.
| Prescribed diagnostic tests and treatments | Benchmarks, % | Study data, n (%) | Difference with period 1 (pre-guideline) % (95% CI) | ||||||
|---|---|---|---|---|---|---|---|---|---|
| PHIS databasea, [12] | Systematic review [13] | Period 1b | Period 2b | Period 3b | Period 2 (early post-guideline) | Period 3 (late post-guideline) | |||
| (2010–2012) | (2015–2016) | (2017–2018) | |||||||
| n = 14 882 | n = 12 114 | n = 434 | n = 216 | n = 313 | |||||
| Before ED presentation | Bronchodilators | 19%a | 16% | 103 (23.7) | 35 (16.2) | 54 (17.3) | -7.5 (-1.2 to -13.9) | -6.5 (-0.7 to -12.3) | |
| Oral corticosteroids | 6% a | 1% | 6 (1.4) | 2 (0.9) | 7 (2.2) | -0.5 (-2.1 to +1.2) | +0.9 (-1.1 to +2.8) | ||
| Inhaled corticosteroids | - | - | 2 (0.5) | 1 (0.5) | 6 (1.9) | 0 (-1.1 to +1.1) | +1.5 (-0.2 to +3.1) | ||
| Antibiotics | 19% a | 17% | 25 (5.8) | 19 (8.8) | 21 (6.7) | +3.0 (-1.3 to +7.4) | +0.9 (-2.6 to +4.5) | ||
| In hospital | Bronchodilators | 19% | 16% | 141 (32.5) | 55 (25.5) | 53 (16.9) | -7.0 (-14.3 to +0.3) | -15.6 (-21.6 to -9.5) | |
| Oral corticosteroids | 6% | 1% | 5 (1.2) | 7 (3.2) | 7 (2.2) | +2.1 (-0.5 to +4.7) | +1.1 (-0.8 to +3.0) | ||
| Inhaled corticosteroids | - | - | 0 (0.0) | 1 (0.5) | 1 (0.3) | +0.5 (-0.4 to +1.4) | +0.3 (-0.3 to +0.9) | ||
| Antibiotics | 19% | 17% | 20 (4.6) | 18 (8.3) | 28 (8.9) | +3.7 (-0.5 to +7.9) | +4.3 (+0.6 to +8.1) | ||
| Chest radiography | 32% | 42% | 52 (12.0) | 19 (8.8) | 30 (9.6) | -3.2 (-8.1 to +1.7) | -2.4 (-6.9 to +2.1) | ||
CI: confidence interval; ED: emergency department; PHIS: Pediatric Health Information Systems.
a PHIS database includes tertiary care hospital data only, which are less suitable as a comparator for prescriptions made before ED presentation [12].
b The three periods of time were determined as follows: Period 1 preceded the publication of the American Academy of Pediatrics clinical practice guideline on bronchiolitis [3], whereas Period 2 immediately followed publication of the guideline and Period 3 covered year 3 post-guideline publication.