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Decision Making for Children with Obstructive Sleep Apnea without Tonsillar Hypertrophy

Stacey L Ishman1, Alice Tang2, Aliza P Cohen3

  • 1Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA Stacey.Ishman@cchmc.org.

Otolaryngology--Head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery
|December 10, 2015
PubMed

Insights

Pediatric sleep apnea management decisions for children without tonsillar hypertrophy were evidence-based only 34% of the time. This highlights significant gaps in evidence and the need for further research into best practices for this patient group.

Area of Science:

  • Pediatric Sleep Medicine
  • Evidence-Based Practice
  • Clinical Decision-Making

Background:

  • Evidence-based medicine (EBM) is the standard for patient care.
  • The management of obstructive sleep apnea (OSA) in children without tonsillar hypertrophy requires clear guidelines.
  • Adherence to EBM in pediatric subspecialty decisions is not well-characterized.

Purpose of the Study:

  • To evaluate whether pediatric subspecialists' decisions for managing OSA in children without tonsillar hypertrophy align with EBM principles.
  • To identify the proportion of evidence-based versus experience-based clinical decisions.

Main Methods:

  • A prospective, single-institution study was conducted at a multidisciplinary pediatric upper airway center.
  • Twelve pediatric subspecialists from 8 specialties participated, with decisions collected in real-time from clinics and conferences.
  • Physicians' decision-making rationales were recorded and categorized.

Main Results:

  • 324 decisions were analyzed for 58 pediatric patients with OSA.
  • Only 34% of management decisions were evidence-based; 59% were nonevidence-based.
  • Physicians cited specific studies for less than 20% of decisions, with no improvement over time.

Conclusions:

  • A significant portion of OSA management decisions in this pediatric population lack a strong evidence base.
  • Sharing decision rationales did not increase the proportion of evidence-based choices.
  • There is a critical need to identify and address evidence gaps to establish best practices for pediatric OSA management.
Abstract

Keywords:
evidence-based medicinegaps in evidencemedical decision makingobstructive sleep apneapediatric

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