Aim Bronchiolitis has a significant burden on child health and previous studies have shown considerable variation of management. We aimed to audit current national practice of bronchiolitis management against both local trust guidelines and the 2006 SIGN guidelines.
Methods A prospective observational study of infants diagnosed with bronchiolitis took place between 1st November and 31st December 2012 throughout all 13 acute paediatric centres in Wales. An audit proforma was designed using the SIGN guidelines as the gold standard. The local trust guidelines were also used for comparison. Recognised missing case notes were audited retrospectively. Microsoft Excel was utilised for data processing.
Results Data was collected for 752 children (56% male), aged 2 weeks to 12 months. Poor feeding was the most common presenting symptom. Investigations undertaken were variable: 0–69% of children had blood tests (FBC, U&E, CRP, blood culture); 6–36% chest radiographs and 0–76% nasopharyngeal aspirates. Of those children that had chest radiographs, 0–50% had a fever and 0–100% had antibiotics. 0–47% of children received NG feeding and 0–27% had IV fluids; 0–57% received oxygen. Medication used included salbutamol, atrovent, hypertonic saline, saline drops and antibiotics. Criteria for feeding and oxygen saturations on discharge were universally similar (>75% and >94% respectively). Overall compliance across Wales, for investigations, treatment and discharge was 39%. This table details individual hospital compliance with the SIGN guidelines, which was the same as local guidelines:
Conclusion This audit demonstrates the wide variability of management of bronchiolitis within Wales and the suboptimal compliance with both local and SIGN guidelines. Currently an education bundle is being disseminated across all centres, highlighting key areas for improvement. The audit loop will be completed during the forthcoming season, aiming to demonstrate an improvement in compliance and a reduction in management variability following our educational intervention.