Quality Indicators for Pediatric Bronchiolitis and Croup Care in the Emergency Department; a Systematic Review and Meta-Analysis

Introduction: As the quality of care for respiratory diseases in pediatric patients in emergency departments (EDs) becomes increasingly important, this systematic review aims to evaluate the current quality indicators (QIs) specifically designed for the ED management of pediatric bronchiolitis and croup. Methods: We conducted searches in four electronic databases (Scopus, Web of Science, CINAHL, and MEDLINE) from their inception up to February 2024. We focused on English-language qualitative and quantitative publications that suggested or described at least one indicator initiative related to ED care for pediatrics with bronchiolitis and croup diseases. These publications were identified by two reviewers, independently. We extracted study characteristics, all relevant QIs reported, and the percentage of compliance with these QIs, where available. All QIs identified from expert panels and observational studies were grouped by definition and categorized by the Institute of Medicine's (IOM) and Donabedian's frameworks for healthcare quality. The percentage of compliance with the identified QIs as reported by observational studies was pooled using a random effect meta-analysis, when appropriate. Results: A total of 17 studies were identified, comprising 5 expert panel studies and 12 observational studies. Altogether, these studies reported 126 QIs for potential use in EDs for pediatric bronchiolitis and croup patients. Of these, 55 QIs were reported by expert panel studies, and 71 by observational studies. Specifically, 81 QIs were related to bronchiolitis, while 45 pertained to croup patients. In terms of the Donabedian domain, most indicators (96.5%) measured the process of care while a smaller fraction (3.5%) addressed care outcomes. In the Institute of Medicine (IOM) domain, most indicators focused on effectiveness and safety. Observational studies reported the percentage of compliance for 35 QIs identified in the expert studies. It was noted that compliance with these QIs varied significantly between studies and health sectors. Conclusions: The findings of this systematic review highlight significant disparities in compliance to the established QIs, which underscores the urgent need for dedicated strategies to enhance the treatment of pediatric bronchiolitis and croup in ED settings.