The Hidden Value of Variation in Practice

In this issue of Pediatrics, Cogen et al ("Characterization of Inpatient Cystic Fibrosis Pulmonary Exacerbations Using the Pediatric Health Information System Database") use a novel data source from children's hospitals to document surprising variation in many aspects of the inpatient management of CF exacerbations among 38 children's hospitals participating in the CFF Care Center Network. Although consensus guidelines for pulmonary exacerbations were published in 2009, they largely served to point out the weak evidence base for treatment approaches used historically. There are few convincing data on such important issues as when signs and symptoms justify intravenous antibiotic therapy, the optimal monitoring of response and length of therapy, or the choice of antibiotics.