Agreements and controversies of national Guidelines for bronchiolitis:
results from an Italian Survey among paediatricians.
Abstract
Introduction. Significant variations in the management of bronchiolitis
are often recorded, and, in parallel, to recommend a univocal clinical
approach it is not easy and is still questioned. This study is aimed to
evaluate the diagnostic and therapeutic management of bronchiolitis in
children adopted by Italian paediatricians following the national
guidelines. Material and methods. A survey study was designed and
carried out by sending an email an open-ended questionnaire developed by
an expert panel of the Scientific Board of the Italian Society of
Pediatric Allergology and Immunology (SIAIP). Questions were designed
according to the national inter-society consensus document on treatment
and prevention of bronchiolitis in newborns and infants. Results.
Overall, 234 paediatricians were taking part in the study. When
diagnosing bronchiolitis, only 44.01% (103/234) of participants were
correctly following the national guidelines. All participants (100%)
would perform laboratory tests and/or radiological exams. 44.01%
administered oxygen (O2) when O2 saturation was major than 92%. About
the therapeutic regimen, marked discrepancies between national
guidelines and recorded answers were reported. Indications for hospital
admission and discharge criteria were in line with the national
guidelines. Conclusions. There is a significant practise variation in
the management of acute bronchiolitis among Italians physicians. Some
wrong attitudes need to be further discouraged, such use of diagnostic
procedures and therapeutic approaches. Further research is urgently
required to define the best management of patients with bronchiolitis as
well as implement strategies to standardize care and improve the quality
of care.