Management of Pediatric Patients with Bronchiolitis in the Emergency Department

Abstract

We evaluated the pattern and appropriateness of the use of drugs and laboratory data or procedures in 100 patients (average age: six months) with the diagnosis of bronchiolitis during 127 visits to the emergency department. Patients were selected randomly among those seen during 1983. All patients had usual signs and symptoms of bronchiolitis. Adrenergic drugs utilized were epinephrine 1:1000 during 30 visits, epinephrine suspension during 14 visits, metaproterenol during six visits and isoetharine during seven visits. Repeat doses of epinephrine were used in six cases. Therapeutic response to epinephrine was noted in 14 cases but not in nine cases. This information was not available in seven cases. Pulse rate and respiratory rate were measured in all cases. Chest x-rays were done in 46 percent, complete blood count in 19 percent and blood gases in 11 percent of the patients. Patients were sent home with instructions to take metaproterenol in 16 cases, theophylline in 19 cases, acetaminophen in 34 cases and cough preparations in 29 cases. Theophylline products were used in 19 cases. Theophylline dose ranged from 14–20 mg/kg/day except in two patients who received 24 and 40 mg/kg/day. Theophylline serum concentrations were determined in only two of 19 cases, and one value was unevaluable. Initial response to epinephrine was not documented in many cases who were sent home on continued therapy with metaproterenol or theophylline. Thirty-one cases returned for a follow-up visit to this hospital. These findings demonstrate that: (1) despite a lack of clear evidence of efficacy, a variety of pharmacologic agents were used; (2) serum concentration of theophylline were monitored infrequently; theophylline dose should be individualized based on its serum concentration to minimize potential toxicity; (3) laboratory data or procedures were utilized appropriately; and (4) most patients did not appear for a follow-up evaluation at this hospital for the assessment of drug efficacy, adverse effects and compliance.