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Checking Up on Overuse of Low-Value Tests and Treatments for Children with Bronchiolitis Four Years after the Latest AAP Guidelines

September 29, 2021

Prior to the COVID-19 pandemic, bronchiolitis was the league leader for filling inpatient units and emergency departments and a common cause of acute care visits to outpatient clinics. Although the prevalence of bronchiolitis decreased in association with the mitigation strategies used to contain SARS-CoV-2 during the pandemic, with the relaxing of mitigation efforts, we are seeing a return of bronchiolitis even during the summer season. It will be interesting to see if the bronchiolitis decreases again if mitigation strategies are put back in place in a meaningful way. Whatever happens with bronchiolitis, it is important that we remember the 2014 AAP clinical practice guidelines recommends against routinely checking a CBC, obtaining a chest radiograph, viral testing, and use of bronchodilators, corticosteroids, and antibiotics. Yet these tests and treatments, continue to be used. What do we know about the use of these low-value interventions?

To answer this question, Wolf et al (10.1542/peds.2021-051345) share with us the results of an analysis of the Virginia All-Payers Claims Database. The authors looked at more than 177,000 in this database in 2018 (four years after the AAP bronchiolitis guidelines were published) and identified 8,308 children (5%) with bronchiolitis between the ages of 0 and 23 months. Unfortunately, 56% of those with bronchiolitis received at least one low-value intervention or tests or what the authors refer to as “forms of overuse”. The most commonly overutilized low-value test was RSV testing (26%) and the least overutilized were corticosteroids (9%). Families with commercial insurance were more likely to receive a low-value service. Emergency departments administered more low-value interventions than inpatient settings.  The likelihood of low-value interventions was also higher in rural settings. There are many other interesting findings related to the use of low-value services. The authors share their thoughts on why overuse occurs and what we can do to address low-value care. You’ll breathe easier and maybe even order fewer tests or treatments for your patients with bronchiolitis if you link to this study and learn more.

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