In the Journals

Recommendations inconsistent in pediatric asthma guidelines

Leigh Anne Bakel

Although national and international guidelines for the treatment of pediatric bronchiolitis have many similarities, less agreement is found in guidelines for the treatment of asthma in children, according to a study published in Pediatrics.

“[Discrepancies in guidelines] can cause confusion about the best treatment for the patient, and naivety about the underlying reason for such differences could lead clinicians to inaccurately apply these recommendations in practice,” Leigh Anne Bakel, MD, from the section of pediatric hospital medicine and the clinical effectiveness team in the department of pediatrics at Children’s Hospital Colorado, and colleagues wrote. “… However, little is known about potential guideline treatment recommendation agreement among prevalent pediatric conditions.”

To assess similarities and differences in recommendations from both asthma and bronchiolitis treatment guidelines, the researchers reviewed national and international guidelines collected from databases. The recommendations were sorted into groups: recommend (1), optionally recommend (2), abstain from recommending (3), recommend against a treatment (4), or not addressed by the guideline (5). Unweighted and weighted Cohen’s kappa statistic scores were used to evaluate levels of agreement among recommendations.

Within the seven asthma guidelines assessed, the researchers noted 166 recommendation topics. Of these topics, 69 were found in two or more guidelines. Four bronchiolitis guidelines were examined, and within these guidelines, 46 recommendation topics were recognized. Nearly half of the recommendations were found within two or more guidelines (n = 21).

The overall kappa score for asthma guidelines was observed at 0.03 for both unweighted (95% CI, 0.01 to 0.07) and weighted (95% CI, 0.01 to 0.10) scores. Kappa scores for bronchiolitis guidelines were observed at 0.32 when unweighted (95% CI, 0.16-0.52) and 0.15 when weighted (95% CI, 0.01 to 0.5).

“Although the AAP developed its own system for evaluating the evidence and providing recommendations, evidence is often insufficient, leaving the AAP guideline panel to make recommendations on the basis of little evidence,” Bakel and colleagues wrote. “It will be important for the AAP to be cognizant of the differences between their endorsed guidelines and those of other national and international pediatric societies.” – by Katherine Bortz

Disclosure: The authors report no relevant financial disclosures.

Leigh Anne Bakel

Although national and international guidelines for the treatment of pediatric bronchiolitis have many similarities, less agreement is found in guidelines for the treatment of asthma in children, according to a study published in Pediatrics.

“[Discrepancies in guidelines] can cause confusion about the best treatment for the patient, and naivety about the underlying reason for such differences could lead clinicians to inaccurately apply these recommendations in practice,” Leigh Anne Bakel, MD, from the section of pediatric hospital medicine and the clinical effectiveness team in the department of pediatrics at Children’s Hospital Colorado, and colleagues wrote. “… However, little is known about potential guideline treatment recommendation agreement among prevalent pediatric conditions.”

To assess similarities and differences in recommendations from both asthma and bronchiolitis treatment guidelines, the researchers reviewed national and international guidelines collected from databases. The recommendations were sorted into groups: recommend (1), optionally recommend (2), abstain from recommending (3), recommend against a treatment (4), or not addressed by the guideline (5). Unweighted and weighted Cohen’s kappa statistic scores were used to evaluate levels of agreement among recommendations.

Within the seven asthma guidelines assessed, the researchers noted 166 recommendation topics. Of these topics, 69 were found in two or more guidelines. Four bronchiolitis guidelines were examined, and within these guidelines, 46 recommendation topics were recognized. Nearly half of the recommendations were found within two or more guidelines (n = 21).

The overall kappa score for asthma guidelines was observed at 0.03 for both unweighted (95% CI, 0.01 to 0.07) and weighted (95% CI, 0.01 to 0.10) scores. Kappa scores for bronchiolitis guidelines were observed at 0.32 when unweighted (95% CI, 0.16-0.52) and 0.15 when weighted (95% CI, 0.01 to 0.5).

“Although the AAP developed its own system for evaluating the evidence and providing recommendations, evidence is often insufficient, leaving the AAP guideline panel to make recommendations on the basis of little evidence,” Bakel and colleagues wrote. “It will be important for the AAP to be cognizant of the differences between their endorsed guidelines and those of other national and international pediatric societies.” – by Katherine Bortz

Disclosure: The authors report no relevant financial disclosures.