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BMC Med Res Methodol. 2018 Feb 12;18(1):22. doi: 10.1186/s12874-018-0478-x.

The management of children with bronchiolitis in the Australasian hospital setting: development of a clinical practice guideline.

Author information

1
Child and Adolescent Health Service, Princess Margaret Hospital for Children, Roberts Road Subiaco, Perth, WA, 6008, Australia. sharon.obrien@health.gov.wa.au.
2
School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, Perth, WA, Australia. sharon.obrien@health.gov.wa.au.
3
Child and Adolescent Health Service, Princess Margaret Hospital for Children, Roberts Road Subiaco, Perth, WA, 6008, Australia.
4
School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, Perth, WA, Australia.
5
School of Rural Medicine, University of New England, Armidale, NSW, 2351, Australia.
6
School of Paediatric and Child Health, School of Primary, Aboriginal and Rural health Care, University of Western Australia, Perth, WA, 6840, Australia.
7
Royal Children's Hospital Melbourne, Murdoch Children's Research Institute, 50 Flemington Rd, Parkville, VIC, 3052, Australia.
8
University of Melbourne, Cnr Grattan Street & Royal Parade, Melbourne, VIC, 3010, Australia.
9
Paediatric Emergency Medicine Centre of Research Excellence, Melbourne, Australia.
10
Children's Emergency Department, Starship Children's Hospital, Private Bag 92024, Auckland, 1142, New Zealand.

Abstract

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.

KEYWORDS:

Baby; Bronchiolitis; Child; Emergency department; Guideline; Hospital; Infant; Management; Paediatric; Respiratory; Viral infection

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