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Variations in bronchiolitis management between five New Zealand hospitals: Can we do better?

Authors

  • AM Vogel,

    1. 1 Department of Paediatrics, 2 South Auckland Clinical School and 3Department of Paediatrics, University of Auckland, 4Starship Children's Hospital, Auckland, 5Health Waikato, Hamilton, 6Departments of Paediatrics and Child Health, Wellington School of Medicine and Health Sciences, Wellington and 7Christchurch School of Medicine, Christchurch, New Zealand
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  • 1 DR Lennon,

    1. 1 Department of Paediatrics, 2 South Auckland Clinical School and 3Department of Paediatrics, University of Auckland, 4Starship Children's Hospital, Auckland, 5Health Waikato, Hamilton, 6Departments of Paediatrics and Child Health, Wellington School of Medicine and Health Sciences, Wellington and 7Christchurch School of Medicine, Christchurch, New Zealand
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  • 2 JE Harding,

    1. 1 Department of Paediatrics, 2 South Auckland Clinical School and 3Department of Paediatrics, University of Auckland, 4Starship Children's Hospital, Auckland, 5Health Waikato, Hamilton, 6Departments of Paediatrics and Child Health, Wellington School of Medicine and Health Sciences, Wellington and 7Christchurch School of Medicine, Christchurch, New Zealand
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  • 3 RE Pinnock,

    1. 1 Department of Paediatrics, 2 South Auckland Clinical School and 3Department of Paediatrics, University of Auckland, 4Starship Children's Hospital, Auckland, 5Health Waikato, Hamilton, 6Departments of Paediatrics and Child Health, Wellington School of Medicine and Health Sciences, Wellington and 7Christchurch School of Medicine, Christchurch, New Zealand
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  • 4 DA Graham,

    1. 1 Department of Paediatrics, 2 South Auckland Clinical School and 3Department of Paediatrics, University of Auckland, 4Starship Children's Hospital, Auckland, 5Health Waikato, Hamilton, 6Departments of Paediatrics and Child Health, Wellington School of Medicine and Health Sciences, Wellington and 7Christchurch School of Medicine, Christchurch, New Zealand
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  • 5 K Grimwood,

    1. 1 Department of Paediatrics, 2 South Auckland Clinical School and 3Department of Paediatrics, University of Auckland, 4Starship Children's Hospital, Auckland, 5Health Waikato, Hamilton, 6Departments of Paediatrics and Child Health, Wellington School of Medicine and Health Sciences, Wellington and 7Christchurch School of Medicine, Christchurch, New Zealand
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  • and 6 PK Pattemore 7

    1. 1 Department of Paediatrics, 2 South Auckland Clinical School and 3Department of Paediatrics, University of Auckland, 4Starship Children's Hospital, Auckland, 5Health Waikato, Hamilton, 6Departments of Paediatrics and Child Health, Wellington School of Medicine and Health Sciences, Wellington and 7Christchurch School of Medicine, Christchurch, New Zealand
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 Dr AM Vogel, South Auckland Health, Private Bag 93311, South Auckland Mail Centre, New Zealand. Fax: +64 9 263 0539; email: alvogel@middlemore.co.nz

Abstract

Objectives:  To determine the current management of bronchiolitis by five major New Zealand hospitals and to identify areas for improvement.

Methods:  Lists of infants under 1 year of age admitted with bronchiolitis during 1998 were obtained from the casemix offices of the five largest New Zealand hospitals with paediatric services. Hospital records from a random sample of these admissions were reviewed.

Results:  Out of the 409 infants admitted overnight, 8% had been born ≤32 weeks gestation and 53% were aged younger than 6 months. Overall, 59% received oxygen, 21% had nasogastric fluids, 22% had intravenous fluids, 34% were prescribed antibiotics, 42% received bronchodilators and 60% had a chest radiograph. Respiratory secretions were collected for viral studies from 58% of infants and, in 59%, respiratory syncytial virus was detected. Significant variations in management were detected between hospitals. The overall proportion of infants requiring oxygen, intravenous or nasogastric fluids (65%) was significantly higher than that found in a 1986−1988 Christchurch study where only 25% received one or more of these interventions (P < 0.001).

Conclusions:  Opportunities exist to rationalize bronchiolitis management in New Zealand with potential cost savings, particularly by reducing the number of chest radiographs and prescribing of unnecessary antibiotics and bronchodilators.

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