Variability in Inpatient Management of Children Hospitalized With Bronchiolitis

Abstract Objective To determine the variability between hospitals in diagnostic testing and management interventions for children with bronchiolitis admitted to inpatient wards and identify its association with patient characteristics. Methods A prospective, multicenter (16 hospitals), multiyear (2007–2010) observational study of children (age Results Of 2207 subjects, 1715 were identified as admitted to inpatient wards. We observed wide variations in the proportion of patients who received diagnostic testing (complete blood count 21–75%, chest radiograph 36–85%) and medications/interventions (bronchodilators 19–91%, systemic corticosteroids 8–44%, antibiotics 17–43%, IV placement 38–93%). Adjusting for demographic and clinical patient characteristics did not materially affect the proportion of variability attributable to hospitals (differences in ICCs with and without model adjustment Conclusions Wide variations in diagnostic test utilization and management interventions seen among children with bronchiolitis treated on the inpatient wards at 16 US hospitals were not attributable to demographic or clinical patient characteristics. These results further support efforts to standardize care for bronchiolitis through active quality improvement strategies.