Comparative Effectiveness, 2008

American Academy of Pediatrics

October 2007

New guidelines on infant bronchiolitis from the American Academy of Pediatrics (AAP) were influenced in part, by findings from AHRQ's Evidence Report No. 69, Management of Bronchiolitis in Infants and Children.

Bronchiolitis is characterized by acute inflammation, edema, and death of the cells that line small airways, along with increased mucus production and bronchospasm. In infants, bronchiolitis is commonly caused by viral lower respiratory tract infection.

AHRQ's evidence report was one of the sources used to formulate the AAP's clinical practice guideline recommendations. A committee—composed of primary care physicians and specialists in the fields of pulmonology, infectious disease, emergency medicine, epidemiology, and medical informatics - systematically graded the quality of evidence and strength of recommendations from the evidence report and other sources.

Danette Stanko-Lopp, a health policy and clinical effectiveness researcher at Cincinnati Children's Hospital Medical Center (CCHMC), served as the primary methodologist on the committee reviewing the evidence. She clarified that "the bronchiolitis EPC report played a distinct role in the development of the AAP guideline, as it was the only source used by the committee that provided a thorough, systematic review of the evidence."

The AAP guideline addresses the diagnosis of bronchiolitis as well as various therapeutic interventions, including bronchodilators, corticosteroids, antiviral and antibacterial agents, hydration, chest physical therapy, and oxygen. Recommendations are made for preventing respiratory syncytial virus (RSV) infection by administering palivizumab by injection and by controlling hospital-acquired spread of infection. Palivizumab provides needed antibodies to protect against RSV infection.

CCHMC maintains and periodically updates approximately 30 evidence-based guidelines, including its guideline for the management of bronchiolitis. Subsequently, "the guidelines are integrated into the hospital's electronic medical records (EMR), so policies and procedures refer to, and are based on, evidence," Stanko-Lopp explains. This includes the addition of point-of-care algorithms and rules for bronchiolitis in the EMR, which were associated with improved consistency of bronchiolitis care and treatment by 20 percent, according to an internal study.

The Evidence Report was prepared for AHRQ by the RTI International-University of North Carolina Evidence-Based Practice Center at Chapel Hill.

Impact Case Study Identifier: COE 08-01
AHRQ Product: Evidence Report
Topic(s): Pediatrics, Guidelines
Scope: National

Management of Bronchiolitis in Infants and Children. Summary, Evidence Report/Technology Assessment: Number 69. AHRQ Publication Number 03-E009, January 2003. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/epcsums/broncsum.htm

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