A predictive model of inappropriate use of medical tests and medications in Bronchiolitis.
A predictive model of inappropriate use of medical tests and medications in Bronchiolitis.
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DOI：
10.11604/pamj.2020.37.94.22712
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发表时间：
2020
期刊：
影响因子：
--
通讯作者：
Rodríguez CA
中科院分区：
文献类型：
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作者：
Buendía JA;Rodríguez CA
很少有研究确定了毛细支气管炎中不适当使用药物和医学检查的预测因素。本研究旨在寻找与毛细支气管炎患者不适当使用药物和检查相关的潜在因素。一项回顾性研究，纳入了2015年1月至2018年12月因毛细支气管炎而在三级中心住院的所有两岁以下婴儿。我们将综合评分定义为主要结局变量。共纳入1930例患者。最常用的处方药物为1789例患者（92.6%）的雾化高渗盐水、沙丁胺醇（56%）和β-内酰胺类抗生素（26.4%）。最常见的医学检查是血象（95.9%），胸部X线（92.2%）和C反应蛋白（79.8%）。在控制了潜在的混杂因素后，发现住院时间的长短增加了不适当使用药物和检查的风险（OR 1.29; CI 95% 1.01-1.65），而发热（OR 0.22; CI 95% 0.06-0.71）和白细胞增多（> 15，000/μL）（OR 0.09; CI 95% 0.03-0.32）可降低不适当使用药物和检查的风险。在我们的人群中，不适当地使用诊断测试和药物治疗毛细支气管炎是一个非常普遍的结果。住院时间较长、无发热且入院时白色血细胞计数正常的患者，不适当使用药物和医学检查的风险增加。
Few studies have identified predictors of inappropriate use of medications and medical tests in bronchiolitis. This study aimed to look for potential factors associated with the inappropriate use of medications and tests in bronchiolitis. A retrospective study that included all infants under two years of age in tertiary center admitted due to Bronchiolitis from January 2015 to December 2018. We defined a composite score as the main outcome variable. 1930 patients were included. The most prescribed medications were nebulized hypertonic saline in 1789 patients (92.6%), albuterol (56%), and β-lactam antibiotics (26.4%). The medical tests more commonly ordered were hemogram (95.9%), chest X-rays (92.2%) and C-reactive protein (79.8%). After controlling for potential confounders, it was found that the length of hospital stay increases the risk of the inappropriate use of medications and tests (OR 1.29; CI 95% 1.01-1.65), whereas fever (OR 0.22; CI 95% 0.06-0.71) and leukocytosis (> 15,000/μL) (OR 0.09; CI 95% 0.03-0.32) at admission decrease the risk of the inappropriate use of medications and tests. Inappropriate use of diagnostic tests and drugs for bronchiolitis was a highly prevalent outcome in our population. Patients with longer hospitalizations, absence of fever and a normal white blood cell count at admission, were at increased risk of inappropriate use of medications and medical tests.