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Methodology of the Updated and Expanded Australasian Bronchiolitis Guideline
Kate Loveys1, Emma J Tavender2,3,4, Franz E Babl2,3,5
1Department of Paediatrics: Child and Youth Health, School of Medicine, The University of Auckland, Auckland, New Zealand.
Insights
The Australasian Bronchiolitis Guideline was updated to improve infant care, incorporating new evidence on management, intensive care, and RSV prevention. This ensures evidence-based practices for bronchiolitis in infants across Australia and New Zealand.
Area of Science:
- Pediatric infectious diseases
- Respiratory medicine
- Clinical practice guidelines
Background:
- Bronchiolitis is a leading cause of infant hospitalizations in Australia and New Zealand (AoNZ).
- Previous guidelines (2016) aimed to standardize care and reduce ineffective therapies.
- The 2022 update addresses new evidence, intensive care, SARS-CoV-2 co-infection, and RSV prevention.
Purpose of the Study:
- To outline the methodology for updating the Australasian Bronchiolitis Guideline.
- To ensure adherence to AGREE and CheckUp reporting standards for guideline development.
- To provide updated, evidence-based recommendations for infant bronchiolitis management.
Main Methods:
- A multidisciplinary Guideline Development Committee (29 experts) and consumer input guided the update.
- Systematic literature searches identified 13,932 articles, with 431 synthesized for 41 scoping questions.
- GRADE methodology assessed evidence quality, with recommendations finalized by consensus voting.
Main Results:
- The guideline update resulted in 41 recommendations (33 evidence-based, 8 consensus-based).
- Key revisions include 11 new and 7 significantly updated recommendations.
- Recommendations cover investigations, management, and Respiratory Syncytial Virus (RSV) prevention.
Conclusions:
- The Australasian Bronchiolitis Guideline has been comprehensively updated and expanded.
- The update followed rigorous AGREE and CheckUp reporting standards.
- The revised guideline provides current, evidence-based management strategies for infant bronchiolitis.
Background:
Bronchiolitis is the most common reason for hospital admission in infants in Australia and Aotearoa New Zealand (AoNZ), with care historically affected by practice variation, including use of ineffective therapies. The Paediatric Research in Emergency Departments International Collaborative (PREDICT) developed the first Australasian (Australia, AoNZ) bronchiolitis guideline in 2016, providing evidence-based guidance on the management of infants (< 12 months of age), presenting or admitted to hospital with bronchiolitis. In 2022, PREDICT initiated a guideline update to include new evidence and expand the scope to include intensive care (up to intubation), management of SARS-CoV-2 co-infection, and respiratory syncytial virus prevention.
Aim:
This article outlines the methodology used in the guideline update, following AGREE and CheckUp reporting standards.
Methods:
A Guideline Advisory Group and Guideline Development Committee, consisting of 29 clinical and methodological experts from Australasia, developed the guideline with consumer input. Forty-one scoping questions on 25 topics were investigated. Systematic searches were performed by a subject librarian across five electronic databases (last search 24/01/24). Screening of 13,932 new articles occurred independently, in duplicate in two stages. The results of 431 articles were synthesized narratively and quantitatively where appropriate, per topic. Risk of bias was evaluated using appropriate tools. GRADE methodology was used to assess evidence quality and develop the recommendations, which were finalised through consensus voting across three guideline development meetings.
Results:
The update produced 41 recommendations (33 evidence-based, 8 consensus-based; including 11 new and 7 with key revisions), covering bronchiolitis investigations, management and RSV prevention. Interest-holder groups consulted on the recommendations.
Conclusion:
The Australasian Bronchiolitis Guideline was updated and expanded according to AGREE and CheckUp reporting standards.
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