Antibiotic and Bronchodilator Prescribing for Acute Bronchitis in the Emergency Department

Jason C. Kroening-Roche, MD; Arash Soroudi, MD; Edward M. Castillo, PHD, MPH; Gary M. Vilke, MD, FACEP, FAAEM

Disclosures

J Emerg Med. 2012;43(2):221-227. 

In This Article

Materials and Methods

This is a retrospective study conducted via structured chart data extraction of all patients presenting to the EDs of two urban academic medical centers in San Diego, California from January 1 through December 31, 2008 with a primary diagnosis of acute bronchitis. This diagnosis was defined by attending and resident physician entry of acute bronchitis into the patient's electronic medical chart on discharge from the ED. All resident physician chart entry was subject to required review by the attending physician on duty, and a separate attending note was written. A total of 836 patients fit this criterion, and were included in the study. Factors such as patient age, gender, chief complaint, and medications prescribed during the visit were obtained from the database. Additionally, the attending physician notes were queried for information regarding duration of cough, comorbid conditions, and social history (e.g., smoking, alcohol abuse, and drug use) as documented by the physician at the time of the patient interview. Severity of substance abuse was not reported. If no history of a comorbid condition (e.g., chronic obstructive pulmonary disease [COPD], asthma, human immunodeficiency virus/acquired immune deficiency syndrome [HIV/AIDS]) was noted in the history of present illness or in nurses' or physicians' notes on past medical history, it was assumed none existed. No patients with a diagnosis of acute bronchitis during our specified study timeframe were excluded from the study.

Institutional Review Board approval was obtained through the University of California San Diego's Human Subject's Protection Program.

Frequencies, percentages, means, and associated SDs were used to describe the patient population. The relationship between patient factors and the frequency of antibiotic prescribing was then analyzed using chi-squared analysis. p-Values < 0.05 were considered significant. Logistic regression was used to assess factors that might be independently associated with prescribing antibiotics. Odds ratios (ORs), 95% confidence intervals (CIs), and associated p-values are reported. Data were analyzed with SPSS, version 17.0 (SPSS, Inc., Chicago, IL).

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