Pediatric Academic Societies Annual Meeting

Pediatric Academic Societies Annual Meeting

May 01, 2016
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National, international guidelines inconsistent for asthma treatment

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BALTIMORE — National and global guideline recommendations for the treatment of asthma are inconsistent, according to research presented at the Pediatric Academic Societies Meeting.

“There was demonstrated variability in national and international guideline recommendations for childhood asthma,” Leigh Anne Bakel, MD, associate medical director of clinical effectiveness at Children’s Hospital Colorado, told Infectious Diseases in Children. “Both the level of evidence and the strength of the recommendation impacted the variability of the recommendations given among the guidelines.”

Leigh Anne Bakel, MD

Leigh Anne Bakel

Bakel and colleagues searched through seven guidelines: the Global Initiative for Asthma, Australian Asthma Handbook, the Canadian Thoracic Society, the Canadian Paediatric Society, the Scottish Intercollegiate Guidelines Network/British Thoracic Society, the National Heart, Lung, and Blood Institute, and the American College of Chest Physicians.

Each guideline’s recommendation was classified as: recommend for, optionally recommend, abstain from recommending, recommend against a treatment, and not addressed in the guideline.

A guideline variability index (GVI) — the sum of the distance of each value from the mean — was used to calculate the variability between recommendations. Guideline variability (GV) was computed by taking the square root of GVI. Adjusted and unadjusted linear regression analyses assessed the association of GV with recommendation level factors which consisted of level of evidence supporting the recommendation, strength of recommendation, age, severity and treatment type.

Sixty-nine recommendations were given in two or more guidelines. Treatment recommendations varied with a GV from 0.49 to 2.14 (mean, 1.7).

A substantial link between the adult age group (−1.02; 95% CI, –1.99 to –0.06) and severity of exacerbation (−0.35; 95% CI, –0.64 to –0.06) with GV was observed in the unadjusted evaluation. When controlling for confounders the mean level of evidence (0.54; 95% CI, 0.0-1.09) and mean strength of recommendation (−0.68; 95% CI, –1.3 to –0.07) were associated with GV.

“Our next steps will be to look at guideline level factors and asthma or condition level factors and their impact on guideline variability,” Bakel said. – by Alaina Tedesco

Reference:

Bakel LA, et al. Abstract 1488.319. Presented at: Pediatric Academic Societies Meeting; April 30-May 3, 2016; Baltimore.

Disclosure: The researchers report no relevant financial disclosures.