One of the more common inpatient admissions to a pediatric floor (and nowadays even an adult floor) is a child, teen, or young adult with a CF exacerbation that is getting worse despite maximizing the outpatient regimen for a patient. So when such a patient needs admission, you might think there is a protocol followed that would be similar in other hospitals admitting similar patients, but perhaps not. To look at the consistency and variability of inpatient CF admissions for pulmonary exacerbations, Cogen et al. (10.1542/peds.2016-2642) looked at guideline recommended diagnostic and management plans including selection of antibiotics and their duration, use of systemic corticosteroids, and when to get pulmonary function tests (PFTs) in a retrospective cross-sectional study of 38 children’s hospitals that are in the US Pediatric Health Information System database as well as are accredited CF Foundation care centers over a five-year period.
The results show more variation than expected in such things as use of hypertonic saline which ranged from 11 to 100%, azithromycin (from 5 to 83%) and systemic corticosteroids (3 to 61%) as well as in frequency of PFTs. Pulmonologists Drs. John McBride from Akron Children’s Hospital and Dennis Stokes form University of Tennessee (10.1542/peds.2016-3876) shed some light on these findings and cough up an insightful commentary helping us move forward and improve care to all children hospitalized with CF in the setting of the variations reported here. With the CF-Foundation a leader in stressing quality of care to their patients, this study and commentary can only result in all of us taking a moment to reflect and then collaborate with all centers caring for children with CF to make sure that we are all doing what is evidence-based or at least the agreed upon consensus for best care for CF inpatients while we learn to improve even more from the best outcomes of the variations identified in this large study population.
