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Children's Health

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More conservative approach recommended for inpatient treatment of infants with viral lower respiratory infection

In the United States, 1 to 2 percent of all children are hospitalized for a viral lower respiratory illness (VLRI) such as bronchiolitis during their childhood. A recent study, which was supported by the Agency for Healthcare Research and Quality (contract 290-95-0042), indicates that a more conservative approach to treatment of VLRI in hospitalized infants would not affect their recovery but could reduce use of hospital resources and related costs.

Researchers from the University of Virginia Children's Medical Center in Charlottesville and International Severity Information Systems, Inc., used the Pediatric Comprehensive Severity Index and patient charts of 601 infants less than a year old with VLRI (bronchiolitis or respiratory syncytial virus pneumonia) to correlate hospital practice variation with illness severity and resource use at 10 children's medical centers. Overall, infants with similar severity of illness received very different care at different hospitals, yet nearly all had uniformly good outcomes.

Intensity of therapy bore little relationship to infants' severity of illness but was a primary determinant of hospital costs and length of stay. For example, hospital average severity of illness scores correlated negatively with frequency of pediatric intensive care unit admission and either negatively or poorly with frequency of intubation (which varied from 0 to 26 percent of infants at different hospitals) and average costs. These varied practices amidst uniformly good infant outcomes at each hospital suggest that many therapies were used indiscriminately.

For example, antibiotics were used in 64 percent of infants despite the accepted viral basis of this disease and the rarity of additional bacterial infection. Also, despite a demonstrated lack of efficacy of corticosteroids in VLRI, one hospital used them in 61 percent of infants. The use of inhaled beta agonists in 92 percent of patients was more difficult to assess because the literature is equivocal. Use of other therapies was similarly idiosyncratic. Greater hospital use of each of these interventions was associated with higher costs, and some were associated with longer hospital stays.

See "Effect of practice variation on resource utilization in infants hospitalized for viral lower respiratory illness," by Douglas F. Willson, M.D., Susan D. Horn, Ph.D., Owen Hendley, M.D., and others, in the October 2001 Pediatrics 108(4), pp. 851-855.

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