The management of children with bronchiolitis in the Australasian hospital setting: Development of a clinical practice guideline
© 2018 The Author(s). Background: Bronchiolitis is the commonest respiratory infection in children less than 12 months and cause of hospitalisation in infants under 6 months of age in Australasia. Unfortunately there is substantial variation in management, despite high levels of supporting evide...
| Main Authors: | , , , , , , |
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| Format: | Journal Article |
| Language: | English |
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BMC
2018
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| Subjects: | |
| Online Access: | http://hdl.handle.net/20.500.11937/80080 |
| _version_ | 1848764157654990848 |
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| author | O'Brien, S. Wilson, Sally Gill, Fenella Cotterell, E. Borland, Meredith Oakley, E. Dalziel, S.R. |
| author_facet | O'Brien, S. Wilson, Sally Gill, Fenella Cotterell, E. Borland, Meredith Oakley, E. Dalziel, S.R. |
| author_sort | O'Brien, S. |
| building | Curtin Institutional Repository |
| collection | Online Access |
| description | © 2018 The Author(s).
Background: Bronchiolitis is the commonest respiratory infection in children less than 12 months and cause of hospitalisation in infants under 6 months of age in Australasia. Unfortunately there is substantial variation in management, despite high levels of supporting evidence. This paper reports on the process, strengths and challenges of the hybrid approach used to develop the first Australasian management guideline relevant to the local population. Method: An adaption of the nine steps recommended by the National Health and Medical Research Council (NHMRC) and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology were utilised. Following establishment of the Guideline Development Committee (GDC), we identified the population, intervention, comparator, outcomes and time of interest (PICOt) questions, undertook a systematic literature search and graded the evidence and recommendations using the NHMRC and GRADE processes. Using Nominal Group Techniques (NGT), consensus was sought in formulating the clinical practice recommendations and practice points. Key health professional bodies were consulted to ensure relevance in the Australasian emergency and ward settings. Results: From 33 PICOT questions, clinical recommendations for practice that were deemed relevant to the Australasian population were identified. Specific considerations for the management of Australian and New Zealand indigenous infants in relation to the use of azithromycin and risk factors for more serious illness are included. Using NGT, consensus demonstrated by a median Likert score > 8 for all recommendations was achieved. The guideline presents clinical guidance, followed by the key recommendations and evidence review behind each recommendation. Conclusion: Developing evidence-based clinical guidelines is a complex process with considerable challenges. Challenges included having committee members located over two countries and five time zones, large volume of literature and variation of member's knowledge of grading of evidence and recommendations. The GRADE and NHMRC processes provided a systematic and transparent approach ensuring a final structure including bedside interface, and a descriptive summary of the evidence base and tables for each key statement. Involvement of stakeholders who will ultimately be end-users as members of the GDC provided valuable knowledge. Lessons learnt during this guideline development process provide valuable insight for those planning development of evidence-based guidelines. |
| first_indexed | 2025-11-14T11:14:54Z |
| format | Journal Article |
| id | curtin-20.500.11937-80080 |
| institution | Curtin University Malaysia |
| institution_category | Local University |
| language | English |
| last_indexed | 2025-11-14T11:14:54Z |
| publishDate | 2018 |
| publisher | BMC |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | curtin-20.500.11937-800802021-01-05T08:07:08Z The management of children with bronchiolitis in the Australasian hospital setting: Development of a clinical practice guideline O'Brien, S. Wilson, Sally Gill, Fenella Cotterell, E. Borland, Meredith Oakley, E. Dalziel, S.R. Science & Technology Life Sciences & Biomedicine Health Care Sciences & Services Bronchiolitis Guideline Infant Management Respiratory Viral infection Baby Paediatric Child Emergency department Hospital QUALITY RECOMMENDATIONS CONSENSUS STRENGTH DELPHI © 2018 The Author(s). Background: Bronchiolitis is the commonest respiratory infection in children less than 12 months and cause of hospitalisation in infants under 6 months of age in Australasia. Unfortunately there is substantial variation in management, despite high levels of supporting evidence. This paper reports on the process, strengths and challenges of the hybrid approach used to develop the first Australasian management guideline relevant to the local population. Method: An adaption of the nine steps recommended by the National Health and Medical Research Council (NHMRC) and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology were utilised. Following establishment of the Guideline Development Committee (GDC), we identified the population, intervention, comparator, outcomes and time of interest (PICOt) questions, undertook a systematic literature search and graded the evidence and recommendations using the NHMRC and GRADE processes. Using Nominal Group Techniques (NGT), consensus was sought in formulating the clinical practice recommendations and practice points. Key health professional bodies were consulted to ensure relevance in the Australasian emergency and ward settings. Results: From 33 PICOT questions, clinical recommendations for practice that were deemed relevant to the Australasian population were identified. Specific considerations for the management of Australian and New Zealand indigenous infants in relation to the use of azithromycin and risk factors for more serious illness are included. Using NGT, consensus demonstrated by a median Likert score > 8 for all recommendations was achieved. The guideline presents clinical guidance, followed by the key recommendations and evidence review behind each recommendation. Conclusion: Developing evidence-based clinical guidelines is a complex process with considerable challenges. Challenges included having committee members located over two countries and five time zones, large volume of literature and variation of member's knowledge of grading of evidence and recommendations. The GRADE and NHMRC processes provided a systematic and transparent approach ensuring a final structure including bedside interface, and a descriptive summary of the evidence base and tables for each key statement. Involvement of stakeholders who will ultimately be end-users as members of the GDC provided valuable knowledge. Lessons learnt during this guideline development process provide valuable insight for those planning development of evidence-based guidelines. 2018 Journal Article http://hdl.handle.net/20.500.11937/80080 10.1186/s12874-018-0478-x English http://creativecommons.org/licenses/by/4.0/ BMC fulltext |
| spellingShingle | Science & Technology Life Sciences & Biomedicine Health Care Sciences & Services Bronchiolitis Guideline Infant Management Respiratory Viral infection Baby Paediatric Child Emergency department Hospital QUALITY RECOMMENDATIONS CONSENSUS STRENGTH DELPHI O'Brien, S. Wilson, Sally Gill, Fenella Cotterell, E. Borland, Meredith Oakley, E. Dalziel, S.R. The management of children with bronchiolitis in the Australasian hospital setting: Development of a clinical practice guideline |
| title | The management of children with bronchiolitis in the Australasian hospital setting: Development of a clinical practice guideline |
| title_full | The management of children with bronchiolitis in the Australasian hospital setting: Development of a clinical practice guideline |
| title_fullStr | The management of children with bronchiolitis in the Australasian hospital setting: Development of a clinical practice guideline |
| title_full_unstemmed | The management of children with bronchiolitis in the Australasian hospital setting: Development of a clinical practice guideline |
| title_short | The management of children with bronchiolitis in the Australasian hospital setting: Development of a clinical practice guideline |
| title_sort | management of children with bronchiolitis in the australasian hospital setting: development of a clinical practice guideline |
| topic | Science & Technology Life Sciences & Biomedicine Health Care Sciences & Services Bronchiolitis Guideline Infant Management Respiratory Viral infection Baby Paediatric Child Emergency department Hospital QUALITY RECOMMENDATIONS CONSENSUS STRENGTH DELPHI |
| url | http://hdl.handle.net/20.500.11937/80080 |