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Bronchiolitis management preferences and the influence of pulse oximetry and respiratory rate on the decision to admit.

Publication ,  Journal Article
Mallory, MD; Shay, DK; Garrett, J; Bordley, WC
Published in: Pediatrics
January 2003

OBJECTIVE: High incidence, rising admission rates, and relatively ineffective therapies make the management of bronchiolitis controversial. Since 1980, the rate of hospitalization for children with bronchiolitis has increased by nearly 250%, whereas mortality rates for the disease have remained constant. It has been speculated that the increasing use of pulse oximetry has lowered the threshold for admission and may have contributed to the rise in bronchiolitis-related admissions. The objective of this study was to describe pediatric emergency medicine physicians' management preferences regarding infants with moderately severe bronchiolitis and to assess the influence of specific differences in oxygen saturation as measured by pulse oximetry (SpO2) and respiratory rate (RR) on the decision to admit. METHODS: Physicians who are members of the American Academy of Pediatrics Section of Emergency Medicine and living in the United States were randomized into 4 groups and mailed a survey that contained 1 of 4 vignettes. Vignettes were identical except for given SpO2 values (94% or 92%) and RR (50/min or 65/min). Subjects were asked to answer questions regarding laboratory tests, treatment options, and the decision to admit for the patient in their vignette. RESULTS: We received completed surveys from 519 (64%) of the 812 physicians contacted. Most respondents recommended use of bronchodilators (96%), nasal suction (82%), and supplemental oxygen (57%). Few respondents recommended decongestants (9%), steroids (8%), or antibiotics (2%). When asked to rank therapies, respondents gave nasal suction 182 number 1 votes; bronchodilators received 164. The decision to admit varied with SpO2 and RR. Forty-three percent of respondents who received a vignette featuring SpO2 of 94% and a RR of 50/min recommended admission for the infant in their vignette. Fifty-eight percent recommended admission when the vignette SpO2 was 94% and RR was 65/min (chi2 = 5.021). Respondents who received a vignette with SpO2 of 92% were nearly twice as likely to recommend admission: 83% recommended admission when vignette RR was 50/min, and 85% recommended admission when vignette RR was 65/min (chi2 = 0.126). CONCLUSIONS: When treating infants with moderately severe bronchiolitis, pediatricians who work in emergency departments frequently use bronchodilators and nasal suction, 2 practices for which supporting data are either conflicting (bronchodilators) or nonexistent (nasal suction). In addition, their decisions to admit differ markedly on the basis of only a 2% difference in SpO2. It is possible that increased reliance on pulse oximetry has contributed to the increase in bronchiolitis hospitalization rates seen during the past 2 decades.

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Published In

Pediatrics

DOI

EISSN

1098-4275

Publication Date

January 2003

Volume

111

Issue

1

Start / End Page

e45 / e51

Location

United States

Related Subject Headings

  • United States
  • Respiratory Function Tests
  • Respiration
  • Practice Patterns, Physicians'
  • Population Surveillance
  • Pediatrics
  • Pediatrics
  • Patient Admission
  • Oxygen
  • Oximetry
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Mallory, M. D., Shay, D. K., Garrett, J., & Bordley, W. C. (2003). Bronchiolitis management preferences and the influence of pulse oximetry and respiratory rate on the decision to admit. Pediatrics, 111(1), e45–e51. https://doi.org/10.1542/peds.111.1.e45
Mallory, Michael D., David K. Shay, Joanne Garrett, and W Clayton Bordley. “Bronchiolitis management preferences and the influence of pulse oximetry and respiratory rate on the decision to admit.Pediatrics 111, no. 1 (January 2003): e45–51. https://doi.org/10.1542/peds.111.1.e45.
Mallory MD, Shay DK, Garrett J, Bordley WC. Bronchiolitis management preferences and the influence of pulse oximetry and respiratory rate on the decision to admit. Pediatrics. 2003 Jan;111(1):e45–51.
Mallory, Michael D., et al. “Bronchiolitis management preferences and the influence of pulse oximetry and respiratory rate on the decision to admit.Pediatrics, vol. 111, no. 1, Jan. 2003, pp. e45–51. Pubmed, doi:10.1542/peds.111.1.e45.
Mallory MD, Shay DK, Garrett J, Bordley WC. Bronchiolitis management preferences and the influence of pulse oximetry and respiratory rate on the decision to admit. Pediatrics. 2003 Jan;111(1):e45–e51.

Published In

Pediatrics

DOI

EISSN

1098-4275

Publication Date

January 2003

Volume

111

Issue

1

Start / End Page

e45 / e51

Location

United States

Related Subject Headings

  • United States
  • Respiratory Function Tests
  • Respiration
  • Practice Patterns, Physicians'
  • Population Surveillance
  • Pediatrics
  • Pediatrics
  • Patient Admission
  • Oxygen
  • Oximetry