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Original article
Retrospective audit of guidelines for investigation and treatment of bronchiolitis: a French perspective
  1. Myriam Benhamida,
  2. Tiphaine Bihouee,
  3. Marie Verstraete,
  4. Christèle Gras Le Guen,
  5. Elise Launay
  1. Clinique Médicale de Pédiatrie, Hôpital Mère Enfant, Centre Hospitalier Universitaire Nantes, Nantes, France
  1. Correspondence to Dr Myriam Benhamida; myriam.benhamida{at}chu-nantes.fr

Abstract

Introduction As the most recent French bronchiolitis guidelines were published in 2000, there is a current overinvestigation and an overtreatment of infants hospitalised with bronchiolitis in France. In 2012, the Group of Pediatric University Hospitals in Western France (‘HUGO’) proposed new evidence-based clinical practice guidelines in keeping with the latest international guidelines. We hypothesise that the implementation of these guidelines contributed to the quality improvement of the management of bronchiolitis in our hospital. The aim of this study was to determine the impact of these guidelines on the management of bronchiolitis inpatients.

Methods This retrospective before/after study design was conducted in the general paediatric unit of a tertiary care French hospital, looking at 1 year before (ie, the winter of 2011–2012) and 1 year after (ie, the winter of 2013–2014) the implementation of the guidelines. Two hundred and eighty bronchiolitis inpatients, all less than 1 year of age, 115 in 2011–2012 and 165 in 2013–2014, were included. The primary outcome we sought to evaluate was the proportion of children administered a diagnostic test associated with a treatment not routinely recommended by the guidelines. As balancing measures, we evaluated the length of stay, the intensive care unit transfer and the readmission rates.

Results Following implementation of the guidelines, use of any given treatment associated with a diagnostic test was reduced by 66% (p<0.001). There were major decreases in the use of chest X-ray (86%vs26%, p<0.001), antibiotics (38%vs13%, p<0.001) and corticosteroids (10%vs3%, p=0.011). Balancing measures were not significantly different.

Conclusions HUGO guidelines were effective at reducing the administration of unnecessary diagnostic tests and medications. This study was the first step in convincing French paediatricians to streamline their practices until updated national guidelines are published.

  • evidence based medicine
  • general paediatrics
  • infectious diseases
  • respiratory

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Footnotes

  • The results of this study were presented at the annual meeting of the French Pediatric Society in May 2016 in Lille (France).

  • Contributors MB, CGLG, MV and EL designed the study. EL and CGLG supervised the study. MB was responsible for the data collection. MB and CGLG performed the data analysis. MB wrote the first draft of the manuscript. All authors interpreted the data, contributed to writing and revising the manuscript and take full responsibility for the integrity of the data and the accuracy of the data analysis.

  • Competing interests None declared.

  • Ethics approval The project was approved by the institutional review board at the Nantes University Hospital and was in accordance with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. French legislation stipulates that informed consent is not required, and local retrospective data may be used for an epidemiological study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Relevant anonymised data are available on reasonable request from the corresponding author.

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