■病毒测试和治疗,如全身性类固醇和吸入性皮质类固醇是常规毛细支气管炎的低价值护理。我们试图确定COVID-19大流行对毛细支气管炎幼儿低价值护理的影响。
■这是一个回顾,使用儿科健康信息系统数据库的横断面研究。我们纳入了在儿科急诊科就诊的2岁以下的毛细支气管炎患儿。我们选择了先验的3个研究期:2018年9月至2020年2月(前期),2020年3月至2022年8月(大流行早期),和2022年9月至2023年1月(大流行晚期)。低价值护理包括呼吸道合胞病毒检测,胸部X线摄影术,沙丁胺醇,或皮质类固醇,并在3个时间段进行了比较。
■在45%中至少提供了1种低价值护理元素,47%,44%的人在大流行中相遇,早期大流行,以及大流行后期,分别。沙丁胺醇和胸部X线摄影的使用在不同时间段几乎没有变化,从流行前到流行早期和晚期组,全身皮质类固醇的使用略有增加。病毒检测从36%的流行前增加到65%的早期大流行和67%的晚期大流行,这似乎是由SARS-CoV-2测试和组合病毒测试驱动的。
■在大流行期间,毛细支气管炎的低价值护理没有临床上的显着变化。因为SARS-CoV-2测试,然而,随着时间的推移,病毒检测的总体频率急剧增加.在未来的质量改进工作中,应考虑整体病毒检测的显着增加。
BACKGROUND: Viral testing and treatments such as systemic steroids and inhaled corticosteroids are low-value care for routine bronchiolitis. We sought to determine the impact of the COVID-19 pandemic on low-value care in young children with bronchiolitis.
METHODS: This was a retrospective, cross-sectional study using the Pediatric Health Information Systems database. We included children <2 years seen in a pediatric emergency department for bronchiolitis. We selected a priori 3 study periods: September 2018 to February 2020 (prepandemic), March 2020 to August 2022 (early pandemic), and September 2022 to January 2023 (late pandemic). Low-value care included respiratory syncytial virus testing, chest radiography,
albuterol, or corticosteroids and was compared across the 3 time periods.
RESULTS: At least 1 element of low-value care was provided in 45%, 47%, and 44% of encounters in the prepandemic, early pandemic, and late pandemic periods, respectively. There was little variation in the use of
albuterol and chest radiography across time periods and a slight increase in systemic corticosteroid use from prepandemic to early and late pandemic groups. Viral testing increased from 36% prepandemic to 65% early pandemic and 67% late pandemic, which appeared to be driven by SARS-CoV-2 testing and combination viral testing.
CONCLUSIONS: There was no clinically significant change in low-value care for bronchiolitis during the pandemic. Because of SARS-CoV-2 testing, however, overall frequency of viral testing increased dramatically over time. This marked increase in overall viral testing should be taken into consideration for future quality improvement efforts.