Mistakes in the diagnosis-treatment of acute bronchiolitis, laryngitis/croup and their effect to the direct cost

The aim of this study is to investigate the frequency and type of these unnecessary procedures and non evidence-based managements used in outpatient practice of acute bronchiolitis, laryngitis / croup and to determine their effects to direct cost.A questionnaire consisting of 10 questions was applied by face to face to the participants who were diagnosed as acute bronchiolitis and laryngitis / croup in pediatric emergency department of Gazi University Hospital in RSV season of 2010-2011.Four hundred and fifty cases included in the study (251 in acute bronchiolitis and 199 in acute laryngitis / croup). Sixty-two percent of infants with acute bronchiolitis (71 / 114) and 88.5% of children with acute laryngitis / croup (31 / 35) were investigated unnecessarily at the time of diagnosis. Non evidence-based medications were used in 51.4% and 26.6% in acute bronchiolitis and acute laryngitis / croup, respectively. Pediatricians were found to do unnecessary investigations and prescribe non evidence-based medications as frequent as general practitioners. The median direct cost per case was increased 1.21 fold and 1.94 fold in acute bronchiolitis and acute laryngitis / croup, respectively in cases who were exposed to any unnecessary procedures compared to the others.Unnecessary investigations and non evidence-based medications are frequently used in diagnosis and management of outpatients with acute bronchiolitis and acute laryngitis / croup. These unnecessary and non evidence?based procedures increase the direct cost of the two common respiratory diseases of childhood significantly.