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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.
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.
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