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Nationwide Adherence to Bell's Palsy Clinical Practice Guidelines: Retrospective Analysis Using a Large-Scale EHR
Nicole Favre1, Ariel Harsinay1, Mattie Rosi-Schumacher1
1Department of Otolaryngology-Head and Neck Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.
Summary
Adherence to Bell's palsy guidelines improved steroid use but increased non-recommended imaging and testing. Further education is needed for better patient care and guideline compliance.
Area of Science:
- Neurology
- Otolaryngology
- Health Services Research
Background:
- Bell's palsy is a common neurological disorder affecting facial nerves.
- The American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) published guidelines in 2013 for its management.
- Evaluating adherence to these guidelines is crucial for optimizing patient outcomes.
Purpose of the Study:
- To assess nationwide adherence to the AAO-HNS guidelines for Bell's palsy management.
- To analyze trends in treatment practices before and after the 2013 guideline publication.
- To identify areas for improvement in clinical practice.
Main Methods:
- Retrospective cohort study using the U.S. TriNetX electronic health record database (2004-2024).
- Identified patients with Bell's palsy (ICD-10 G51.0).
- Collected data on corticosteroid, antiviral use, imaging, and serologic testing within 72 hours of diagnosis.
Main Results:
- Early corticosteroid use significantly increased post-guidelines (20.4% to 33.8%, P<.001).
- Use of non-recommended imaging (32.9% to 41.0%, P<.001) and Borrelia testing (1% to 5%, P<.001) also rose.
- Optional antiviral use increased from 11.8% to 23.5% (P<.001).
Conclusions:
- The AAO-HNS guidelines led to improved early steroid administration for Bell's palsy.
- Increased utilization of discouraged imaging and laboratory tests indicates persistent adherence gaps.
- Further provider education and quality improvement initiatives are necessary to enhance guideline compliance.
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