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A Systematic Review of Clinical Practice Guidelines for the Diagnosis and Management of Bronchiolitis
Abstract Background Bronchiolitis is the leading cause of hospital admission for respiratory disease among infants aged
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| Published in: | The Journal of infectious diseases 2020-10, Vol.222 (Supplement_7), p.S672-S679 |
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| Main Authors: | , , , , , , , , , , , |
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| container_end_page | S679 |
| container_issue | Supplement_7 |
| container_start_page | S672 |
| container_title | The Journal of infectious diseases |
| container_volume | 222 |
| creator | Kirolos, Amir Manti, Sara Blacow, Rachel Tse, Gabriel Wilson, Thomas Lister, Martin Cunningham, Steve Campbell, Alasdair Nair, Harish Reeves, Rachel M Fernandes, Ricardo M Campbell, Harry |
| description | Abstract
Background
Bronchiolitis is the leading cause of hospital admission for respiratory disease among infants aged |
| doi_str_mv | 10.1093/infdis/jiz240 |
| format | article |
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Background
Bronchiolitis is the leading cause of hospital admission for respiratory disease among infants aged <1 year. Clinical practice guidelines can benefit patients by reducing the performance of unnecessary tests, hospital admissions, and treatment with lack of a supportive evidence base. This review aimed to identify current clinical practice guidelines worldwide, appraise their methodological quality, and discuss variability across guidelines for the diagnosis and management of bronchiolitis.
Methods
A systematic literature review of electronic databases EMBASE, Global Health, and Medline was performed. Manual searches of the gray literature, national pediatric society websites, and guideline-focused databases were performed, and select international experts were contacted to identify additional guidelines. The Appraisal of Guidelines for Research and Evaluation assessment tool was used by 2 independent reviewers to appraise each guideline.
Results
Thirty-two clinical practice guidelines met the selection criteria. Quality assessment revealed significant shortcomings in a number of guidelines, including lack of systematic processes in formulating guidelines, failure to state conflicts of interest, and lack of consultation with families of affected children. There was widespread agreement about a number of aspects, such as avoidance of the use of unnecessary diagnostic tests, risk factors for severe disease, indicators for hospital admission, discharge criteria, and nosocomial infection control. However, there was variability, even within areas of consensus, over specific recommendations, such as variable thresholds for oxygen therapy. Guidelines showed significant variability in recommendations for the pharmacological management of bronchiolitis, with conflicting recommendations over whether use of nebulized epinephrine, hypertonic saline, or bronchodilators should be routinely trialled.
Conclusions
Future guidelines should aim to be compliant with international standards for clinical guidelines to improve their quality and clarity and to promote their adoption into practice. Variable recommendations between guidelines may reflect the evolving evidence base for bronchiolitis management, and platforms should be created to understand this variability and promote evidence-based recommendations.</description><identifier>ISSN: 0022-1899</identifier><identifier>EISSN: 1537-6613</identifier><identifier>DOI: 10.1093/infdis/jiz240</identifier><identifier>PMID: 31541233</identifier><language>eng</language><publisher>US: Oxford University Press</publisher><subject>Bronchiolitis - diagnosis ; Bronchiolitis - therapy ; Bronchodilator Agents ; Bronchodilators ; Bronchopneumonia ; Clinical medicine ; Clinical practice guidelines ; Consensus ; Databases, Factual ; Diagnosis ; Evidence-Based Medicine - standards ; Guidelines as Topic ; Hospitalization ; Humans ; Infant ; International standards ; Literature reviews ; Medical diagnosis ; Nosocomial infection ; Oxygen Inhalation Therapy - standards ; Pediatrics ; Public health ; Quality control ; Respiratory diseases ; Risk factors</subject><ispartof>The Journal of infectious diseases, 2020-10, Vol.222 (Supplement_7), p.S672-S679</ispartof><rights>The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com. 2020</rights><rights>The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c323t-578ab86022aeb2c505391f7f70a92c8ff4c9b6dd319534c175ed5e8fe19a8ef43</citedby><cites>FETCH-LOGICAL-c323t-578ab86022aeb2c505391f7f70a92c8ff4c9b6dd319534c175ed5e8fe19a8ef43</cites><orcidid>0000-0002-6169-6262 ; 0000-0002-9432-9100 ; 0000-0003-2995-330X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31541233$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kirolos, Amir</creatorcontrib><creatorcontrib>Manti, Sara</creatorcontrib><creatorcontrib>Blacow, Rachel</creatorcontrib><creatorcontrib>Tse, Gabriel</creatorcontrib><creatorcontrib>Wilson, Thomas</creatorcontrib><creatorcontrib>Lister, Martin</creatorcontrib><creatorcontrib>Cunningham, Steve</creatorcontrib><creatorcontrib>Campbell, Alasdair</creatorcontrib><creatorcontrib>Nair, Harish</creatorcontrib><creatorcontrib>Reeves, Rachel M</creatorcontrib><creatorcontrib>Fernandes, Ricardo M</creatorcontrib><creatorcontrib>Campbell, Harry</creatorcontrib><creatorcontrib>RESCEU Investigators</creatorcontrib><creatorcontrib>RESCEU Investigators</creatorcontrib><title>A Systematic Review of Clinical Practice Guidelines for the Diagnosis and Management of Bronchiolitis</title><title>The Journal of infectious diseases</title><addtitle>J Infect Dis</addtitle><description>Abstract
Background
Bronchiolitis is the leading cause of hospital admission for respiratory disease among infants aged <1 year. Clinical practice guidelines can benefit patients by reducing the performance of unnecessary tests, hospital admissions, and treatment with lack of a supportive evidence base. This review aimed to identify current clinical practice guidelines worldwide, appraise their methodological quality, and discuss variability across guidelines for the diagnosis and management of bronchiolitis.
Methods
A systematic literature review of electronic databases EMBASE, Global Health, and Medline was performed. Manual searches of the gray literature, national pediatric society websites, and guideline-focused databases were performed, and select international experts were contacted to identify additional guidelines. The Appraisal of Guidelines for Research and Evaluation assessment tool was used by 2 independent reviewers to appraise each guideline.
Results
Thirty-two clinical practice guidelines met the selection criteria. Quality assessment revealed significant shortcomings in a number of guidelines, including lack of systematic processes in formulating guidelines, failure to state conflicts of interest, and lack of consultation with families of affected children. There was widespread agreement about a number of aspects, such as avoidance of the use of unnecessary diagnostic tests, risk factors for severe disease, indicators for hospital admission, discharge criteria, and nosocomial infection control. However, there was variability, even within areas of consensus, over specific recommendations, such as variable thresholds for oxygen therapy. Guidelines showed significant variability in recommendations for the pharmacological management of bronchiolitis, with conflicting recommendations over whether use of nebulized epinephrine, hypertonic saline, or bronchodilators should be routinely trialled.
Conclusions
Future guidelines should aim to be compliant with international standards for clinical guidelines to improve their quality and clarity and to promote their adoption into practice. Variable recommendations between guidelines may reflect the evolving evidence base for bronchiolitis management, and platforms should be created to understand this variability and promote evidence-based recommendations.</description><subject>Bronchiolitis - diagnosis</subject><subject>Bronchiolitis - therapy</subject><subject>Bronchodilator Agents</subject><subject>Bronchodilators</subject><subject>Bronchopneumonia</subject><subject>Clinical medicine</subject><subject>Clinical practice guidelines</subject><subject>Consensus</subject><subject>Databases, Factual</subject><subject>Diagnosis</subject><subject>Evidence-Based Medicine - standards</subject><subject>Guidelines as Topic</subject><subject>Hospitalization</subject><subject>Humans</subject><subject>Infant</subject><subject>International standards</subject><subject>Literature reviews</subject><subject>Medical diagnosis</subject><subject>Nosocomial infection</subject><subject>Oxygen Inhalation Therapy - standards</subject><subject>Pediatrics</subject><subject>Public health</subject><subject>Quality control</subject><subject>Respiratory diseases</subject><subject>Risk factors</subject><issn>0022-1899</issn><issn>1537-6613</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNqFkMtOwzAQRS0EoqWwZIsssWET8CNO4mUpT6kIxGMduc4YXCV2sRMQfD2pWkBiw2qkmaOrOwehfUqOKZH8xDpT2Xgyt58sJRtoSAXPkyyjfBMNCWEsoYWUA7QT45wQkvIs30YDTkVKGedDBGP88BFbaFRrNb6HNwvv2Bs8qa2zWtX4LijdnwBfdraCfgsRGx9w-wL4zKpn56ONWLkK3yinnqEB1y4DToN3-sX62rY27qIto-oIe-s5Qk8X54-Tq2R6e3k9GU8TzRlvE5EXalZkfWsFM6YFEVxSk5ucKMl0YUyq5SyrKk6l4KmmuYBKQGGASlWASfkIHa1yF8G_dhDbsrFRQ10rB76LZf9yJiXjOe_Rwz_o3HfB9e1KJoVgXFBGeipZUTr4GAOYchFso8JHSUm59F-u_Jcr_z1_sE7tZg1UP_S38N-Gvlv8k_UFCCGQmg</recordid><startdate>20201007</startdate><enddate>20201007</enddate><creator>Kirolos, Amir</creator><creator>Manti, Sara</creator><creator>Blacow, Rachel</creator><creator>Tse, Gabriel</creator><creator>Wilson, Thomas</creator><creator>Lister, Martin</creator><creator>Cunningham, Steve</creator><creator>Campbell, Alasdair</creator><creator>Nair, Harish</creator><creator>Reeves, Rachel M</creator><creator>Fernandes, Ricardo M</creator><creator>Campbell, Harry</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-6169-6262</orcidid><orcidid>https://orcid.org/0000-0002-9432-9100</orcidid><orcidid>https://orcid.org/0000-0003-2995-330X</orcidid></search><sort><creationdate>20201007</creationdate><title>A Systematic Review of Clinical Practice Guidelines for the Diagnosis and Management of Bronchiolitis</title><author>Kirolos, Amir ; Manti, Sara ; Blacow, Rachel ; Tse, Gabriel ; Wilson, Thomas ; Lister, Martin ; Cunningham, Steve ; Campbell, Alasdair ; Nair, Harish ; Reeves, Rachel M ; Fernandes, Ricardo M ; Campbell, Harry</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c323t-578ab86022aeb2c505391f7f70a92c8ff4c9b6dd319534c175ed5e8fe19a8ef43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Bronchiolitis - diagnosis</topic><topic>Bronchiolitis - therapy</topic><topic>Bronchodilator Agents</topic><topic>Bronchodilators</topic><topic>Bronchopneumonia</topic><topic>Clinical medicine</topic><topic>Clinical practice guidelines</topic><topic>Consensus</topic><topic>Databases, Factual</topic><topic>Diagnosis</topic><topic>Evidence-Based Medicine - standards</topic><topic>Guidelines as Topic</topic><topic>Hospitalization</topic><topic>Humans</topic><topic>Infant</topic><topic>International standards</topic><topic>Literature reviews</topic><topic>Medical diagnosis</topic><topic>Nosocomial infection</topic><topic>Oxygen Inhalation Therapy - standards</topic><topic>Pediatrics</topic><topic>Public health</topic><topic>Quality control</topic><topic>Respiratory diseases</topic><topic>Risk factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kirolos, Amir</creatorcontrib><creatorcontrib>Manti, Sara</creatorcontrib><creatorcontrib>Blacow, Rachel</creatorcontrib><creatorcontrib>Tse, Gabriel</creatorcontrib><creatorcontrib>Wilson, Thomas</creatorcontrib><creatorcontrib>Lister, Martin</creatorcontrib><creatorcontrib>Cunningham, Steve</creatorcontrib><creatorcontrib>Campbell, Alasdair</creatorcontrib><creatorcontrib>Nair, Harish</creatorcontrib><creatorcontrib>Reeves, Rachel M</creatorcontrib><creatorcontrib>Fernandes, Ricardo M</creatorcontrib><creatorcontrib>Campbell, Harry</creatorcontrib><creatorcontrib>RESCEU Investigators</creatorcontrib><creatorcontrib>RESCEU Investigators</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of infectious diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kirolos, Amir</au><au>Manti, Sara</au><au>Blacow, Rachel</au><au>Tse, Gabriel</au><au>Wilson, Thomas</au><au>Lister, Martin</au><au>Cunningham, Steve</au><au>Campbell, Alasdair</au><au>Nair, Harish</au><au>Reeves, Rachel M</au><au>Fernandes, Ricardo M</au><au>Campbell, Harry</au><aucorp>RESCEU Investigators</aucorp><aucorp>RESCEU Investigators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A Systematic Review of Clinical Practice Guidelines for the Diagnosis and Management of Bronchiolitis</atitle><jtitle>The Journal of infectious diseases</jtitle><addtitle>J Infect Dis</addtitle><date>2020-10-07</date><risdate>2020</risdate><volume>222</volume><issue>Supplement_7</issue><spage>S672</spage><epage>S679</epage><pages>S672-S679</pages><issn>0022-1899</issn><eissn>1537-6613</eissn><abstract>Abstract
Background
Bronchiolitis is the leading cause of hospital admission for respiratory disease among infants aged <1 year. Clinical practice guidelines can benefit patients by reducing the performance of unnecessary tests, hospital admissions, and treatment with lack of a supportive evidence base. This review aimed to identify current clinical practice guidelines worldwide, appraise their methodological quality, and discuss variability across guidelines for the diagnosis and management of bronchiolitis.
Methods
A systematic literature review of electronic databases EMBASE, Global Health, and Medline was performed. Manual searches of the gray literature, national pediatric society websites, and guideline-focused databases were performed, and select international experts were contacted to identify additional guidelines. The Appraisal of Guidelines for Research and Evaluation assessment tool was used by 2 independent reviewers to appraise each guideline.
Results
Thirty-two clinical practice guidelines met the selection criteria. Quality assessment revealed significant shortcomings in a number of guidelines, including lack of systematic processes in formulating guidelines, failure to state conflicts of interest, and lack of consultation with families of affected children. There was widespread agreement about a number of aspects, such as avoidance of the use of unnecessary diagnostic tests, risk factors for severe disease, indicators for hospital admission, discharge criteria, and nosocomial infection control. However, there was variability, even within areas of consensus, over specific recommendations, such as variable thresholds for oxygen therapy. Guidelines showed significant variability in recommendations for the pharmacological management of bronchiolitis, with conflicting recommendations over whether use of nebulized epinephrine, hypertonic saline, or bronchodilators should be routinely trialled.
Conclusions
Future guidelines should aim to be compliant with international standards for clinical guidelines to improve their quality and clarity and to promote their adoption into practice. Variable recommendations between guidelines may reflect the evolving evidence base for bronchiolitis management, and platforms should be created to understand this variability and promote evidence-based recommendations.</abstract><cop>US</cop><pub>Oxford University Press</pub><pmid>31541233</pmid><doi>10.1093/infdis/jiz240</doi><orcidid>https://orcid.org/0000-0002-6169-6262</orcidid><orcidid>https://orcid.org/0000-0002-9432-9100</orcidid><orcidid>https://orcid.org/0000-0003-2995-330X</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | The Journal of infectious diseases, 2020-10, Vol.222 (Supplement_7), p.S672-S679 |
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| source | Oxford Journals Online |
| subjects | Bronchiolitis - diagnosis Bronchiolitis - therapy Bronchodilator Agents Bronchodilators Bronchopneumonia Clinical medicine Clinical practice guidelines Consensus Databases, Factual Diagnosis Evidence-Based Medicine - standards Guidelines as Topic Hospitalization Humans Infant International standards Literature reviews Medical diagnosis Nosocomial infection Oxygen Inhalation Therapy - standards Pediatrics Public health Quality control Respiratory diseases Risk factors |
| title | A Systematic Review of Clinical Practice Guidelines for the Diagnosis and Management of Bronchiolitis |
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