115 Emergency Department management adherence to national bronchiolitis guidelines and impact on resource utilization
Bibliographic record
Abstract
Despite guidelines from the Canadian Paediatric Society and American Academy of Pediatrics, marked variation exists regarding bronchiolitis management in the emergency department (ED). We hypothesized that relying on pharmacotherapy to manage symptoms of bronchiolitis sets up misleading expectations for symptom progression and triggers returns to ED (RTED) when it is not effective, yet hospitalization criteria are not met. Primarily to measure the association between deviation from national guidelines and RTED within 7 days from the index visit among infants discharged from the ED with a diagnosis of bronchiolitis. Secondary objectives compared ED length of stay (LOS) between infants managed according to or discrepant to national guidelines. Retrospective case control study of previously healthy infants <12 months of age seeking care at a tertiary care pediatric ED who were discharged home with a clinical diagnosis of bronchiolitis. Deviation from guidelines was defined as salbutamol or steroid use either in the ED or at discharge. We used multi-variable logistic regressions to assess the association between management deviating from national guidelines and RTED. We used the Mann-Whitney U test to compare LOS. We included a total of 185 subjects, 91 infants with RTED for bronchiolitis and 94 matched controls. The proportion treated with salbutamol in the ED was comparable between the two groups (RTED 36% vs. controls 34%). Steroid use was higher in the RTED group (19%) vs. controls (10%) but was not statistically significant. Adjusting for acuity of index visit, age, presence of tachypnea, oxygen desaturation, and signs of dehydration, the OR for RTED if deviation from guidelines occurred was 0.98 (95% CI: 0.47 to 2.03; p 0.976). Deviation occurred in 39% of cases. ED length of stay was significantly longer among infants whose management deviated from national guidelines (247.4 vs. 187.2 minutes, p 0.004). Deviation from national guidelines did not appear to be associated with higher odds of RTED. Using non-recommended treatments is associated with significantly longer ED stays and thus increased resource utilization.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.018 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".