Youshani Amir Saam, Mehta Bimal, Davies Katharine, Beer Helen, De Sujata
Department of Otolaryngology, Salford Royal NHS Foundation Trust, Salford, UK.
Department of Accident & Emergency, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.
Emerg Med J. 2015 Apr;32(4):274-80. doi: 10.1136/emermed-2013-202385. Epub 2013 Dec 6.
We carried out a complete audit cycle, reviewing our management of paediatric patients with Bell's palsy within 72 h of symptom onset. Our protocol was published after the initial audit in 2009, and a re-audit was carried out in 2011. We aimed to improve our current practice in accordance with up-to-date evidence-based research on the use of steroids and antivirals.
A total of 17 patients were included in the first cycle, but only eight patients met our inclusion and exclusion criteria for the re-audit. We assessed documentation of House-Brackmann (HB) grade on presentation, initial treatment, follow-up and recovery.
The first cycle revealed inconsistent management with steroids (41%), antivirals (6%), steroids and antivirals (6%) or nothing at all (47%). In addition, only 65% of patients were followed-up in the ear, nose and throat (ENT) clinic. Our management protocol was published in 2010, and a re-audit was completed. Our results showed 100% compliance with steroid treatment and 100% follow-up with the ENT team. A thorough literature review revealed some additional benefit from the use of antivirals.
At present there is insufficient evidence to discount the use of steroids and antivirals. Therefore, with our new management protocol, we recommend the use of steroids in patients presenting within 72 h of symptom onset, and antivirals for patients with a HB grade of IV or higher.
我们开展了一个完整的审核周期，回顾了症状出现72小时内小儿贝尔面瘫患者的管理情况。我们的方案在2009年首次审核后发布，并于2011年进行了重新审核。我们旨在根据关于使用类固醇和抗病毒药物的最新循证研究改进当前的做法。
第一个周期共纳入17例患者，但重新审核时只有8例患者符合我们的纳入和排除标准。我们评估了就诊时、初始治疗、随访及恢复情况的House-Brackmann（HB）分级记录。
第一个周期显示，类固醇治疗管理不一致（41%）、抗病毒药物治疗管理不一致（6%）、类固醇和抗病毒药物治疗管理不一致（6%）或根本未治疗（47%）。此外，只有65%的患者在耳鼻喉科（ENT）门诊接受了随访。我们的管理方案于2010年发布，并完成了重新审核。我们的结果显示，类固醇治疗的依从性为100%，ENT团队的随访率为100%。全面的文献综述显示，使用抗病毒药物有一些额外益处。
目前没有足够的证据否定使用类固醇和抗病毒药物。因此，根据我们新的管理方案，我们建议在症状出现72小时内就诊的患者中使用类固醇，对于HB分级为IV级或更高的患者使用抗病毒药物。
