Differences in management of bronchiolitis between hospitals in The Netherlands

Abstract

To study the variation in management of acute bronchiolitis in the Netherlands, a questionnaire on the use of diagnostic and therapeutic procedures and prescription of drugs after discharge was mailed to all 110 hospital-based paediatric practices in the Netherlands. A 100% response rate was achieved. There was a great deal of variation in management of bronchiolitis between respondents. The most commonly applied diagnostic procedures were immunofluorescence staining of nasopharyngeal secretions for respiratory syncytial virus (100% of respondents), blood gas analysis (93%), leucocyte count/differentiation and serum C-reactive protein levels (92%), and chest X-rays (83%). Most respondents used supplemental oxygen (100%) and tube feeding (96%) when needed, and gave nebulized bronchodilators, either as a trial (59%) or in a fixed schedule (33%). Antibiotics for suspected bacterial co-infection were used by 69% of respondents. Corticosteroids were used for severe cases by 35% of respondents; ribavirin was only used in 11% of hospitals for treatment of children from high-risk groups. When children had responded favourably to bronchodilators during admission, these drugs were continued after discharge by 69% of respondents; more than half of these also prescribed inhaled corticosteroids to these children.

Conclusion Considerable variation in management of bronchiolitis exists between hospitals in the Netherlands. Several diagnostic and therapeutic approaches are used which are not evidence based, probably reflecting the lack of therapeutic options with proven clinical efficacy for this condition.