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Inpatient Care for Uncomplicated Bronchiolitis
Comparison With Milliman and Robertson Guidelines
Narendra M. Kini, MD, MHA;
James M. Robbins, PhD;
Mark S. Kirschbaum, RN, PhD;
Stephanie J. Frisbee, MSc;
Uma R. Kotagal, MBBS, MSc;
for the Child Health Accountability Initiative
Arch Pediatr Adolesc Med. 2001;155:1323-1327.
Context Bronchiolitis is the most common lower respiratory tract infection in
infancy. A recent Centers for Disease Control and Prevention report confirmed
that hospitalization rates for bronchiolitis have increased 2.4-fold from
1980 to 1996. Controversies exist about optimal treatment plans. Milliman
and Robertson recommend ambulatory care management; in case of hospitalization,
the recommended length of stay is 1 day.
Objectives To relate actual practice variation for infants admitted with uncomplicated
bronchiolitis to Milliman and Robertson's recommendations.
Design Prospective observational study.
Setting General care wards of 8 pediatric hospitals of the Child Health Accountability
Initiative during the winter of 1998-1999.
Patients First-time admissions for uncomplicated bronchiolitis in patients not
previously diagnosed as having asthma and who were younger than 1 year.
Main Outcome Measures Respiratory rate, monitored interventions, attainment of discharge criteria
goals, and length of stay.
Results Eight hundred forty-six patients were included in the final analysis:
85.7% were younger than 6 months, 48.5% were nonwhite, and 64.1% were Medicaid
recipients or self-pay. On admission to the hospital, 18.3% of the infants
had respiratory rates higher than higher than 80 breaths per minute, 53.8%
received supplemental oxygen therapy, and 52.6% received intravenous fluids.
These proportions decreased to 1.9%, 33.8%, and 20.3%, respectively, 1 day
after admission, and to 0.7%, 20.1%, and 8.6%, respectively, 2 days after
admission. The average length of stay was 2.8 days (SD, 2.3 days).
Conclusions Milliman and Robertson's recommendations do not correspond to practice
patterns observed at the hospitals participating in this study; no hospital
met the Milliman and Robertson recommended 1-day goal length of stay. Administration
of monitored intervention persisted past the second day of hospitalization.
From the Center for Quality and Outcomes Management (Dr Kini and Ms
Frisbee), Children's Hospital of Wisconsin, Milwaukee; Center for Applied
Research and Evaluation, Arkansas Children's Hospital, Little Rock (Dr Robbins);
Child Health Corporation of America, Overland Park, Kan (Dr Kirschbaum); and
the Health Policy and Clinical Effectiveness Program, Children's Hospital
Medical Center, Cincinnati, Ohio (Dr Kotagal).
Corresponding author: Narendra M. Kini, MD, MSHA, Children's Hospital
of Wisconsin, 9000 W Wisconsin Ave, PO Box 1997–MS 950, Milwaukee, WI
53201 (e-mail: nkini{at}chw.org).
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