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Bell's palsy in children: Current treatment patterns in Australia and New Zealand. A PREDICT study
Franz E Babl1,2,3, Kaya K Gardiner2, Amit Kochar4
1Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia.
Insights
Pediatric Bell's palsy treatment varies in Australasian emergency departments. Prednisolone is frequently used, and this study confirms the feasibility of a randomized controlled trial (RCT) for its effectiveness in children.
Area of Science:
- Pediatric Neurology
- Emergency Medicine
- Clinical Trials
Background:
- Bell's palsy etiology and clinical course may differ between pediatric and adult patients.
- There is a lack of randomized placebo-controlled trials (RCTs) demonstrating the effectiveness of prednisolone for pediatric Bell's palsy.
- Current treatment practices for pediatric Bell's palsy in Australasian Emergency Departments (EDs) are not well-documented.
Purpose of the Study:
- To assess current management practices for pediatric Bell's palsy in Australian and New Zealand Emergency Departments (EDs).
- To determine the feasibility of conducting a multicenter RCT for pediatric Bell's palsy within the Paediatric Research in Emergency Departments International Collaborative (PREDICT) network.
Main Methods:
- A retrospective analysis of ED medical records for children under 18 diagnosed with Bell's palsy between January 1, 2012, and December 31, 2013.
- Data collection included presentation details, diagnosis, and management, entered into an online database (REDCap).
- Searches used Bell's palsy related terms, excluding repeat presentations for the same illness but including relapses.
Main Results:
- 323 presentations were analyzed from 14 PREDICT sites, with a mean age of 9.0 years (57.0% female).
- Most children (73.7%) presented within 72 hours of symptom onset; 52.0% had seen a doctor previously.
- Steroids were administered in 67.5% of cases, with prednisolone commonly prescribed (9 days, ~1 mg/kg/day, with tapering in 35.7%).
Conclusions:
- Treatment for pediatric Bell's palsy in Australasian EDs is inconsistent.
- Prednisolone is frequently used despite limited high-level pediatric evidence.
- The study supports the feasibility of conducting an RCT to evaluate prednisolone for pediatric Bell's palsy.
Aim:
The aetiology and clinical course of Bell's palsy may be different in paediatric and adult patients. There is no randomised placebo controlled trial (RCT) to show effectiveness of prednisolone for Bell's palsy in children. The aim of the study was to assess current practice in paediatric Bell's palsy in Australia and New Zealand Emergency Departments (ED) and determine the feasibility of conducting a multicentre RCT within the Paediatric Research in Emergency Departments International Collaborative (PREDICT).
Methods:
A retrospective analysis of ED medical records of children less than 18 years diagnosed with Bell's palsy between 1 January, 2012 and 31 December, 2013 was performed. Potential participants were identified from ED information systems using Bell's palsy related search terms. Repeat presentations during the same illness were excluded but relapses were not. Data on presentation, diagnosis and management were entered into an online data base (REDCap).
Results:
Three hundred and twenty-three presentations were included from 14 PREDICT sites. Mean age at presentation was 9.0 (SD 5.0) years with 184 (57.0%) females. Most (238, 73.7%) presented to ED within 72 h of symptoms, 168 (52.0%) had seen a doctor prior. In ED, 218 (67.5%) were treated with steroids. Prednisolone was usually prescribed for 9 days at around 1 mg/kg/day, with tapering in 35.7%.
Conclusion:
Treatment of Bell's palsy in children presenting to Australasian EDs is varied. Prednisolone is commonly used in Australasian EDs, despite lack of high-level paediatric evidence. The study findings confirm the feasibility of an RCT of prednisolone for Bell's palsy in children.
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