Bronchiolitis Management in Pediatric Emergency Departments in Australia and New Zealand A PREDICT Study

Objectives: Bronchiolitis is the most frequent reason for admission in infants. We set out to compare clinical practice guideline (CPG) recommendations and physician management of bronchiolitis at Paediatric Research in Emergency Departments International Collaborative (PREDICT) sites in Australia and New Zealand as a baseline for prospective trials. Methods: (i) Review of bronchiolitis CPGs from PREDICT sites. (ii) Survey of senior pediatric emergency physicians at PREDICT sites to determine management strategies in bronchiolitis. Results: All 11 PREDICT sites participated. Ten sites used a specific bronchiolitis CPG. beta-agonists were not recommended unless the child was older or asthma was suspected. Eight sites did not and 2 sites only recommended corticosteroids for older infants in whom asthma was likely. For rehydration, 7 sites recommended intravenous (IV) fluids exclusively or in the acute phase, with 3 recommending nasogastric (NG) fluids in the recovery phase or for difficult vascular access. Two sites recommended NG fluids for moderate and IV fluids for severe bronchiolitis. Physician response rate was 78/83 (94%). No medications were used for mild (94%) or moderate (83%) bronchiolitis. Inhaled beta-agonists were used by 5% for moderate and 18% for severe bronchiolitis. Steroids were not used by any physicians for mild or moderate and was used by only 3% for severe bronchiolitis. The preferred mode of rehydration was IV in 45%, NG in 49%, and either one depending on disease severity in 6%. Conclusions: Management of bronchiolitis was similar across PREDICT sites. Practice is equally split between IV and NG rehydration. This reflects a lack of evidence which should be addressed through a multicenter comparative trial.