ArticleBMC pediatrics2026
Current approaches to acute bronchiolitis management among pediatricians: guideline adherence and practice variation.
Article in BMC pediatrics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundAlthough evidence-based clinical guidelines recommend supportive care as the mainstay of acute bronchiolitis management, significant variability in diagnostic and therapeutic practices among pediatricians persists. Identifying factors associated with guideline adherence may help reduce the gap between evidence-based recommendations and real-world practice.
methodsThis cross-sectional study was conducted between January and December 2023 using a structured, web-based questionnaire administered to pediatricians working in different clinical settings. Data were collected on demographic characteristics, use of bronchiolitis severity scoring systems, adherence to clinical guidelines, diagnostic and treatment preferences for moderate and severe bronchiolitis in pediatric emergency departments and wards. Participants were categorized based on guideline adherence and professional status (resident or specialist).
resultsA total of 239 pediatricians participated. 38.1% of pediatricians reported routine use of a bronchiolitis severity scoring system, while 59.8% reported adherence to at least one clinical guideline. Guideline adherence was significantly higher among residents and among those using severity scoring systems. Oxygen and hydration were the most commonly preferred across all settings. The use of nebulized therapies and systemic steroids increased with disease severity, despite limited recommendations in guidelines. Non-recommended therapies remained frequently used, particularly in severe cases. Pediatricians adhering to guidelines showed a stronger preference for supportive care, whereas non-adherent pediatricians more often favored nebulized bronchodilators. Especially in cases of moderate acute bronchiolitis, pediatricians adhering to guidelines used oxygen significantly more frequently (p = 0.012), while those who did not adhere used salbutamol significantly more frequently (p < 0.005).
conclusionsConsiderable variability remains in the management despite established clinical guidelines. Disease severity, professional experience, and use of severity scoring systems influence adherence to evidence-based practices. Targeted educational interventions may help improve guideline implementation and promote supportive, high-value care in pediatric settings.
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