Guideline-Discordant Bronchiolitis Care in Community Emergency Departments
Abstract
OBJECTIVES
To determine demographic and clinical predictors of guideline discordant care (GDC) that children with uncomplicated bronchiolitis receive in community emergency departments (EDs) and to explore the association between GDC and ED length (LOS) for children who meet criteria for supportive care alone.
STUDY DESIGN
We conducted a retrospective observational study from 2017-2024 of ED patients 28 days -2 years old lacking comorbidities with bronchiolitis. All children were discharged home from the 21 community EDs in our Northern California health system. Our primary outcome was GDC, which was defined as receipt of ≥1 test or intervention discordant with guidelines from the American Academy of Pediatrics (AAP) and included bronchodilators, chest radiography, steroids, or antibiotics. A secondary outcome was ED LOS. We analyzed patient and clinical characteristics associated with GDC and its association with ED LOS using multivariable regression.
RESULTS
We included 6,083 patient encounters in which AAP guideline application would be justified; most had normal triage vital signs (86%), and all were discharged home. Most patients (62%) received ≥1 measure of GDC; chest radiography (41%) and albuterol (37%) were most common. GDC was associated with longer median ED LOS (142 min, 95% CI: 140-145 min) compared with no GDC (84 min, 95% CI: 82-86 min). After adjustment, abnormal vital signs, older age, male sex, and past albuterol exposurewere associated with increased…
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