The management of children with bronchiolitis in the Australasian hospital setting: development of a clinical practice guideline
Abstract Background Bronchiolitis is the commonest respiratory infection in children less than 12 months and cause of hospitalisation in infants under 6 months of age in Australasia. Unfortunately there is substantial variation in management, despite high levels of supporting evidence. This paper re...
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| Format: | Article |
| Language: | English |
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BMC
2018-02-01
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| Series: | BMC Medical Research Methodology |
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| Online Access: | http://link.springer.com/article/10.1186/s12874-018-0478-x |
| _version_ | 1819266229957820416 |
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| author | Sharon O’Brien Sally Wilson Fenella J. Gill Elizabeth Cotterell Meredith L Borland Edward Oakley Stuart R Dalziel on behalf of the Paediatric Research in Emergency Departments International Collaborative (PREDICT) network, Australasia |
| author_facet | Sharon O’Brien Sally Wilson Fenella J. Gill Elizabeth Cotterell Meredith L Borland Edward Oakley Stuart R Dalziel on behalf of the Paediatric Research in Emergency Departments International Collaborative (PREDICT) network, Australasia |
| author_sort | Sharon O’Brien |
| collection | DOAJ |
| description | Abstract Background Bronchiolitis is the commonest respiratory infection in children less than 12 months and cause of hospitalisation in infants under 6 months of age in Australasia. Unfortunately there is substantial variation in management, despite high levels of supporting evidence. This paper reports on the process, strengths and challenges of the hybrid approach used to develop the first Australasian management guideline relevant to the local population. Method An adaption of the nine steps recommended by the National Health and Medical Research Council (NHMRC) and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology were utilised. Following establishment of the Guideline Development Committee (GDC), we identified the population, intervention, comparator, outcomes and time of interest (PICOt) questions, undertook a systematic literature search and graded the evidence and recommendations using the NHMRC and GRADE processes. Using Nominal Group Techniques (NGT), consensus was sought in formulating the clinical practice recommendations and practice points. Key health professional bodies were consulted to ensure relevance in the Australasian emergency and ward settings. Results From 33 PICOT questions, clinical recommendations for practice that were deemed relevant to the Australasian population were identified. Specific considerations for the management of Australian and New Zealand indigenous infants in relation to the use of azithromycin and risk factors for more serious illness are included. Using NGT, consensus demonstrated by a median Likert score > 8 for all recommendations was achieved. The guideline presents clinical guidance, followed by the key recommendations and evidence review behind each recommendation. Conclusion Developing evidence-based clinical guidelines is a complex process with considerable challenges. Challenges included having committee members located over two countries and five time zones, large volume of literature and variation of member’s knowledge of grading of evidence and recommendations. The GRADE and NHMRC processes provided a systematic and transparent approach ensuring a final structure including bedside interface, and a descriptive summary of the evidence base and tables for each key statement. Involvement of stakeholders who will ultimately be end-users as members of the GDC provided valuable knowledge. Lessons learnt during this guideline development process provide valuable insight for those planning development of evidence-based guidelines. |
| first_indexed | 2024-12-23T20:57:58Z |
| format | Article |
| id | doaj.art-86c2a84707f84217a82cbb951da06459 |
| institution | Directory Open Access Journal |
| issn | 1471-2288 |
| language | English |
| last_indexed | 2024-12-23T20:57:58Z |
| publishDate | 2018-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Medical Research Methodology |
| spelling | doaj.art-86c2a84707f84217a82cbb951da064592022-12-21T17:31:27ZengBMCBMC Medical Research Methodology1471-22882018-02-0118111110.1186/s12874-018-0478-xThe management of children with bronchiolitis in the Australasian hospital setting: development of a clinical practice guidelineSharon O’Brien0Sally Wilson1Fenella J. Gill2Elizabeth Cotterell3Meredith L Borland4Edward Oakley5Stuart R Dalziel6on behalf of the Paediatric Research in Emergency Departments International Collaborative (PREDICT) network, AustralasiaChild and Adolescent Health Service, Princess Margaret Hospital for ChildrenChild and Adolescent Health Service, Princess Margaret Hospital for ChildrenChild and Adolescent Health Service, Princess Margaret Hospital for ChildrenSchool of Rural Medicine, University of New EnglandChild and Adolescent Health Service, Princess Margaret Hospital for ChildrenRoyal Children’s Hospital Melbourne, Murdoch Children’s Research InstituteChildren’s Emergency Department, Starship Children’s HospitalAbstract Background Bronchiolitis is the commonest respiratory infection in children less than 12 months and cause of hospitalisation in infants under 6 months of age in Australasia. Unfortunately there is substantial variation in management, despite high levels of supporting evidence. This paper reports on the process, strengths and challenges of the hybrid approach used to develop the first Australasian management guideline relevant to the local population. Method An adaption of the nine steps recommended by the National Health and Medical Research Council (NHMRC) and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology were utilised. Following establishment of the Guideline Development Committee (GDC), we identified the population, intervention, comparator, outcomes and time of interest (PICOt) questions, undertook a systematic literature search and graded the evidence and recommendations using the NHMRC and GRADE processes. Using Nominal Group Techniques (NGT), consensus was sought in formulating the clinical practice recommendations and practice points. Key health professional bodies were consulted to ensure relevance in the Australasian emergency and ward settings. Results From 33 PICOT questions, clinical recommendations for practice that were deemed relevant to the Australasian population were identified. Specific considerations for the management of Australian and New Zealand indigenous infants in relation to the use of azithromycin and risk factors for more serious illness are included. Using NGT, consensus demonstrated by a median Likert score > 8 for all recommendations was achieved. The guideline presents clinical guidance, followed by the key recommendations and evidence review behind each recommendation. Conclusion Developing evidence-based clinical guidelines is a complex process with considerable challenges. Challenges included having committee members located over two countries and five time zones, large volume of literature and variation of member’s knowledge of grading of evidence and recommendations. The GRADE and NHMRC processes provided a systematic and transparent approach ensuring a final structure including bedside interface, and a descriptive summary of the evidence base and tables for each key statement. Involvement of stakeholders who will ultimately be end-users as members of the GDC provided valuable knowledge. Lessons learnt during this guideline development process provide valuable insight for those planning development of evidence-based guidelines.http://link.springer.com/article/10.1186/s12874-018-0478-xBronchiolitisGuidelineInfantManagementRespiratoryViral infection |
| spellingShingle | Sharon O’Brien Sally Wilson Fenella J. Gill Elizabeth Cotterell Meredith L Borland Edward Oakley Stuart R Dalziel on behalf of the Paediatric Research in Emergency Departments International Collaborative (PREDICT) network, Australasia The management of children with bronchiolitis in the Australasian hospital setting: development of a clinical practice guideline BMC Medical Research Methodology Bronchiolitis Guideline Infant Management Respiratory Viral infection |
| title | The management of children with bronchiolitis in the Australasian hospital setting: development of a clinical practice guideline |
| title_full | The management of children with bronchiolitis in the Australasian hospital setting: development of a clinical practice guideline |
| title_fullStr | The management of children with bronchiolitis in the Australasian hospital setting: development of a clinical practice guideline |
| title_full_unstemmed | The management of children with bronchiolitis in the Australasian hospital setting: development of a clinical practice guideline |
| title_short | The management of children with bronchiolitis in the Australasian hospital setting: development of a clinical practice guideline |
| title_sort | management of children with bronchiolitis in the australasian hospital setting development of a clinical practice guideline |
| topic | Bronchiolitis Guideline Infant Management Respiratory Viral infection |
| url | http://link.springer.com/article/10.1186/s12874-018-0478-x |
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