An observational study in Bronchiolitis, sponsored by St. Justine's Hospital. Recruiting at 15 sites in Canada. Open to participants aged 28 Days to 12 Months. Per ClinicalTrials.gov, last updated 2025-07-23.
Sponsored by St. Justine's Hospital · Observational
Low-value care is defined as the use of a health service, such as diagnostics and treatments, for which the harms or costs outweigh the benefits. In pediatrics, investigations or treatments can be unpleasant or traumatizing to the child, can prolong the time spent in hospital, and can create a cascade of further futile investigations and treatments. Several of the commonly used diagnostics and treatments in bronchiolitis are considered low-value, making it a great model to study low-value care in pediatrics.
The purpose of CareBEST is to study the use of 6 low-value healthcare services in children aged 1 to 12 months hospitalized with bronchiolitis, their costs, and measure the variability in practice of these services.
The main questions this study aims to answer are:
How frequently are 6 low-value care health services used in children hospitalized with bronchiolitis? These 6 low-value care health services are: 1) respiratory virus testing; 2) chest x-rays; 3) continuous pulse oximetry; 4) short-acting beta-agonists; 5) systemic corticosteroids; and 6) antibiotics.
Participants will have their infant's medical chart reviewed during their hospitalization. They will also have 2 short questionnaires to complete, once during their child's admission to the hospital, and one 30 days later to ask about whether their child required any additional medical care. They will additionally be asked to complete a questionnaire on their perceptions regarding their child's care while hospitalized, including the use of shared-decision making and their understanding of and involvement in the care decisions made.
This analysis will provide a better understanding of treatment of bronchiolitis in Canada and help in the development of effective interventions to reduce low-value care.
Background: Low-value care is defined as the use of a health service, such as diagnostics and treatments, for which the harms or costs outweigh the benefits. Reducing low-value care is important in improving the health of Canadians and achieving a sustainable, high-quality healthcare system. Bronchiolitis is among the most common and most costly causes of hospitalizations in children. Most healthcare costs associated with bronchiolitis are related to hospitalization, and these costs have been increasing. Supportive care is recommended by national guidelines for the treatment of bronchiolitis, and many commonly used diagnostics and treatments in bronchiolitis are considered low-value, making it a great model to study low-value care in pediatrics. To develop effective interventions to reduce low-value care, and ensure the right resources go to the right patient at the right time, it is crucial to develop a better understanding of inpatient management of bronchiolitis in Canada.
The goal of this prospective multi-site observational study is to analyze the use of 6 low-value healthcare services in children diagnosed with bronchiolitis, their costs, and measure the variability in practice of these services.
Specific objectives: Among infants admitted with bronchiolitis at 15 Canadian hospitals with pediatric admissions, to:
Design: A multi-centre (n=15), prospective observational cohort study of children hospitalized with bronchiolitis. Data will be obtained from medical charts and entered into a central, web-based REDCap database. A health equity questionnaire will be completed by participants once during their child's admission and then again 30 days later to inquire on additional medical care required post-admission. Secondary outcomes and covariates will also be collected which include but are not limited to duration of ICU stay, use of mechanical ventilation, cardiac arrest, length of hospital stay, disease severity, clinician years of experience, and death.
Analysis of the primary outcome will be descriptive for each low-value health service, overall and stratified by sex. Costs of hospitalization will be assessed from a healthcare institution perspective. Cost of each of low-value health service will be described and compared between one another and across sites to identify key differences which may be targets for process change.
This study will provide important data to understand the use of low-value care in bronchiolitis treatment in Canada, and will inform our approach to addressing low-value care in bronchiolitis and in other common conditions.
289 studies on the registry are indexed under Bronchiolitis; 51 are open to participants now.
This study's planned enrollment of 3,000 is above the median of 200 across 79 observational studies indexed under Bronchiolitis.
Browse Bronchiolitis studies →St. Justine's Hospital is the lead sponsor of 156 studies on the registry; 27 are open to participants now.
Counted across the registry records on this site, refreshed daily.
Children aged >28 days to \<12 months with an admission diagnosis of bronchiolitis.
Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.
Exclusion Criteria:
- Children previously recruited for the study, either during a previous bronchiolitis admission or for the same incident of bronchiolitis, while admitted to another study site.
Children aged \>28 days to \<12 months with an admission diagnosis of bronchiolitis, admitted to a general pediatric inpatient unit, not previously recruited for the study.
Diagnostic Test: Provision of any of six different low-value health services for treatment of bronchiolitis
Children aged \>28 days to \<12 months with an admission diagnosis of bronchiolitis, admitted to a general pediatric inpatient unit, not previously recruited for the study.
Diagnostic Test: Provision of any of six different low-value health services for treatment of bronchiolitis
Children aged \>28 days to \<12 months with an admission diagnosis of bronchiolitis, admitted to a general pediatric inpatient unit, not previously recruited for the study.
Diagnostic Test: Provision of any of six different low-value health services for treatment of bronchiolitis
Children aged \>28 days to \<12 months with an admission diagnosis of bronchiolitis, admitted to a general pediatric inpatient unit, not previously recruited for the study.
Diagnostic Test: Provision of any of six different low-value health services for treatment of bronchiolitis
Children aged \>28 days to \<12 months with an admission diagnosis of bronchiolitis, admitted to a general pediatric inpatient unit, not previously recruited for the study.
Diagnostic Test: Provision of any of six different low-value health services for treatment of bronchiolitis
Children aged \>28 days to \<12 months with an admission diagnosis of bronchiolitis, admitted to a general pediatric inpatient unit, not previously recruited for the study.
Diagnostic Test: Provision of any of six different low-value health services for treatment of bronchiolitis
Children aged \>28 days to \<12 months with an admission diagnosis of bronchiolitis, admitted to a general pediatric inpatient unit, not previously recruited for the study.
Diagnostic Test: Provision of any of six different low-value health services for treatment of bronchiolitis
Children aged \>28 days to \<12 months with an admission diagnosis of bronchiolitis, admitted to a general pediatric inpatient unit, not previously recruited for the study.
Diagnostic Test: Provision of any of six different low-value health services for treatment of bronchiolitis
Children aged \>28 days to \<12 months with an admission diagnosis of bronchiolitis, admitted to a general pediatric inpatient unit, not previously recruited for the study.
Children aged \>28 days to \<12 months with an admission diagnosis of bronchiolitis, admitted to a general pediatric inpatient unit, not previously recruited for the study.
Diagnostic Test: Provision of any of six different low-value health services for treatment of bronchiolitis
Children aged \>28 days to \<12 months with an admission diagnosis of bronchiolitis, admitted to a general pediatric inpatient unit, not previously recruited for the study.
Diagnostic Test: Provision of any of six different low-value health services for treatment of bronchiolitis
Children aged \>28 days to \<12 months with an admission diagnosis of bronchiolitis, admitted to a general pediatric inpatient unit, not previously recruited for the study.
Diagnostic Test: Provision of any of six different low-value health services for treatment of bronchiolitis
Children aged \>28 days to \<12 months with an admission diagnosis of bronchiolitis, admitted to a general pediatric inpatient unit, not previously recruited for the study.
Diagnostic Test: Provision of any of six different low-value health services for treatment of bronchiolitis
Children aged \>28 days to \<12 months with an admission diagnosis of bronchiolitis, admitted to a general pediatric inpatient unit, not previously recruited for the study.
Diagnostic Test: Provision of any of six different low-value health services for treatment of bronchiolitis
Children aged \>28 days to \<12 months with an admission diagnosis of bronchiolitis, admitted to a general pediatric inpatient unit, not previously recruited for the study.
Diagnostic Test: Provision of any of six different low-value health services for treatment of bronchiolitis
This prospective observational will have six separate primary outcomes acting as exposures, (or interventions).The exposures are the the provision of any of the six low-value health services: 1) respiratory virus testing; 2) chest x-ray; 3) continuous pulse oximetry; 4) short-acting beta-agonists; 5) systemic corticosteroids; and 6) antibiotics.
The proportion of eligible patients receiving each of the six low-value health services
The primary outcome of the study is the proportion of patients receiving each of the six low-value health services during their hospitalization for bronchiolitis: 1) respiratory virus testing; 2) chest x-ray; 3) continuous pulse oximetry; 4) short-acting beta-agonists; 5) systemic corticosteroids; and 6) antibiotics.
Time frame: 24 months
Transfer to the ICU
Whether the child admitted with bronchiolitis was transferred to the ICU. If so, duration of ICU stay.
Time frame: 24 months
Use of CPAP, BiPAP, or mechanical ventilation during admission.
Use of continuous positive airway pressure (CPAP) or biphasic positive airway pressure (BiPAP), mechanical ventilation during admission, as documented in patient's admission record.
Time frame: 24 months
Cardiac arrest
Whether the child experienced a cardiac arrest during their admission.
Time frame: 24 months
Death
Whether the child died during their admission.
Time frame: 24 months
Return visits
Using administrative data and parent surveys, we will measure return visits to the Emergency Department, and hospitalizations within 30 days following the initial bronchiolitis admission, overall and for respiratory illness.
Time frame: 24 months
Use of low-flow supplemental oxygen
Any use of low-flow supplemental oxygen, and duration of use.
Time frame: 24 months
Fluid supplementation
Presence and type (intravenous vs. nasogastric) of fluid supplementation
Time frame: 24 months
Nil per os order
Any order for "nil per os" (feeding not permitted) during admission.
Time frame: 24 months
Chest X-ray results
Results of chest X-rays ordered. Obtained from medical record.
Time frame: 24 months
Presence of bacterial co-infection
Presence and type of bacterial co-infections. Obtained from medical record.
Time frame: 24 months
Use of inhaled corticosteroids
Whether inhaled corticosteroids were administered during admission. Obtained from medical record.
Time frame: 24 months
Use of chest physiotherapy
Whether chest physiotherapy was performed during admission. Obtained from medical record.
Time frame: 24 months
Complete blood count
Results of complete blood count. Obtained from medical record. Numerical
Time frame: 24 months
Electrolyte levels
Electrolyte levels in blood. Obtained from medical record. Numerical
Time frame: 24 months
Venous blood gas
Results of blood tests ordered; venous blood gas. Obtained from medical record. Numerical
Time frame: 24 months
Antiviral prescription
Any prescription for an antiviral effective against influenza during admission.Obtained from medical record.
Time frame: 24 months
Prescription at discharge from hospital
Data collection on prescription at discharge from the hospital including the following: 1) repeat chest x-ray; 2) prescription for short-acting beta-agonists (SABA); 3) inhaled corticosteroids; 4) systemic corticosteroids; 5) antibiotics; and 6) antivirals.
Time frame: 24 months
Care received in the 30 days following discharge.
Care received in the 30 days following the patient's discharge from the hospital, including outpatient follow-up appointments in the following 30 days, follow-up chest x-rays, as well as prescription for antibiotics, short-acting beta-agonists, and inhaled corticosteroids.
Time frame: 24 months
Length of stay
Length of hospital stay in hours, both in the ED and inpatient unit, measured using recorded time of arrival and departure to and from the ED and inpatient unit.
Time frame: 24 months
Cost of hospitalization
Cost of hospitalization will be evaluated from a healthcare institution perspective with data from hospital decision support. More detailed costs data (micro-costing) will also be obtained whenever possible, allowing differentiation between services not readily discerned by traditional case costing methods typically based on resource intensity weights.
Time frame: 24 months
Use of Heated humidified high-flow nasal cannula (HHHFNC)
Heated humidified high-flow nasal cannula (HHHFNC) help reduce work of breathing and can be beneficial in severe bronchiolitis cases. We will measure proportion of HHHFNC use in hospitalized children with bronchiolitis stratified by disease severity. Obtained from medical record.
Time frame: 24 months
Not enrolling at this site.
Not enrolling at this site.
Plan to share: No
No publications or documents are linked to this record.
Started Feb 2024 (actual). Primary completion is estimated for May 2026, 27 months after the start.
Of 26 observational studies under Bronchiolitis, half reached primary completion within 24 months of starting (the median), counting those still running; a quarter within 17 and three quarters within 87. This study's planned 27 months is above that.
How these figures are worked out, and which studies are left out of them.
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