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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.

|October 27, 2017

Summary

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.

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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.