Actitud práctica diagnóstica y terapeútica ante la bronquiolitis aguda del lactante en Galicia: (estudio Bronquio-Gal)

• Autores: Federico Martinón Torres, Francisco Contreras Martinón, Lorenzo Redondo Collazo, Antonio Rodríguez Núñez, José María Martinón Sánchez
• Localización: Acta pediátrica española, ISSN 0001-6640, Vol. 65, Nº. 1, 2007, págs. 12-20
• Idioma: español
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• Resumen

  • The diagnosis and treatment of acute bronchiolitis are controversial issues. We proposed to assess the practice patterns of pediatricians in Galicia (Northwest Spain) in the diagnosis and treatment of this disease, and to analyze the influence on the response of professional factors such as medical training, practical experience, and work setting. Material and methods: A cross-sectional observational study consisting of a postal survey that included a clinical case report of acute bronchiolitis and 40 related questions. The survey was submitted in May 2004 to pediatricians belonging to the Pediatric Society of Galicia. Results: A total of 103 correctly completed surveys were returned. Half of the responders (50.5%) were over 45 years of age. Eighty-seven percent of them were pediatricians and 13% were pediatric residents. In all, 58% of the physicians worked in the primary care setting. In most cases, the diagnostic approach followed the current international recommendations, with an especially widespread use of clinical scales and pulse oximetry. In contrast, pharmacological therapies were prescribed more frequently than is recommended, and the use of drugs such as bronchodilators or corticosteroids was nearly generalized. Practical experience did not influence the responses. Respiratory syncytial virus detection assays were more frequently indicated by medical residents (p <0.001). All the complementary tests included in the survey were requested more frequently by in-hospital pediatricians than by primary care pediatricians (p <0.001), with the exception of clinical scales, which were employed to a similar extent in both groups. Oxygen therapy, bronchodilator therapy and, in particular, epinephrine were indicated more frequently in the hospital setting (p <0.001). Conclusions: There are considerable discrepancies between routine practice and the evidence justifying it. A national consensus conference on the management of acute bronchiolitis could help to improve patient care and to rationalize the use of resources.