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International Variation in Asthma and Bronchiolitis Guidelines
Leigh Anne Bakel1, Jemila Hamid2, Joycelyne Ewusie3
1Section of Pediatric Hospital Medicine and the Clinical Effectiveness Team, Department of Pediatrics, Children's Hospital Colorado, Aurora, Colorado; leighanne.bakel@childrenscolorado.org.
Insights
National and international guidelines show low agreement for asthma treatment recommendations compared to bronchiolitis. Further research is needed to understand the reasons for these discrepancies in clinical guidelines.
Area of Science:
- Medical Guidelines
- Clinical Practice
- Respiratory Medicine
Background:
- Clinical practice guidelines are essential for standardizing patient care.
- Variations in guideline recommendations for the same condition can lead to inconsistent treatment approaches.
- Assessing agreement among guidelines is crucial for identifying potential areas for improvement.
Purpose of the Study:
- To quantify the agreement level of treatment recommendations for asthma and bronchiolitis across national and international guidelines.
- To compare the degree of concordance between guidelines for these two distinct respiratory conditions.
Main Methods:
- A systematic search of national and international guidelines was conducted using guideline databases.
- Recommendations were categorized based on their stance (recommend, optionally recommend, abstain, recommend against, not addressed).
- Agreement was statistically evaluated using unweighted and weighted kappa scores.
Main Results:
- Seven asthma guidelines and four bronchiolitis guidelines were analyzed.
- Asthma guidelines exhibited very low agreement (overall kappa 0.03), while bronchiolitis guidelines showed moderate agreement (unweighted kappa 0.32).
- A significant difference in agreement was observed between the two conditions, with bronchiolitis guidelines being more consistent.
Conclusions:
- National and international guidelines demonstrate considerably less agreement on asthma treatments than on bronchiolitis treatments.
- Further investigation is warranted to explore factors influencing these differences, including patient values, economic factors, and guideline-specific elements.
- Understanding these discrepancies is vital for refining and harmonizing clinical practice recommendations.
Background And Objectives:
Guideline recommendations for the same clinical condition may vary. The purpose of this study was to determine the degree of agreement among comparable asthma and bronchiolitis treatment recommendations from guidelines.
Methods:
National and international guidelines were searched by using guideline databases (eg, National Guidelines Clearinghouse: December 16-17, 2014, and January 9, 2015). Guideline recommendations were categorized as (1) recommend, (2) optionally recommend, (3) abstain from recommending, (4) recommend against a treatment, and (5) not addressed by the guideline. The degree of agreement between recommendations was evaluated by using an unweighted and weighted κ score. Pairwise comparisons of the guidelines were evaluated similarly.
Results:
There were 7 guidelines for asthma and 4 guidelines for bronchiolitis. For asthma, there were 166 recommendation topics, with 69 recommendation topics given in ≥2 guidelines. For bronchiolitis, there were 46 recommendation topics, with 21 recommendation topics provided in ≥2 guidelines. The overall κ for asthma was 0.03, both unweighted (95% confidence interval [CI]: -0.01 to 0.07) and weighted (95% CI: -0.01 to 0.10); for bronchiolitis, it was 0.32 unweighted (95% CI: 0.16 to 0.52) and 0.15 weighted (95% CI: -0.01 to 0.5).
Conclusions:
Less agreement was found in national and international guidelines for asthma than for bronchiolitis. Additional studies are needed to determine if differences are based on patient preferences and values and economic considerations or if other recommendation-level, guideline-level, and condition-level factors are driving these differences.
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