Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia.
Population Health Theme, Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Road, Parkville, VIC, 3052, Australia.
Sci Rep. 2021 Apr 8;11(1):7744. doi: 10.1038/s41598-021-87369-7.
Gastro-oesophageal reflux (GOR) is a common physiological state in infants and young children, with gastro-oesophageal reflux disease (GORD) its pathological manifestation. Management of GOR/GORD requires elimination of possible underlying causes, parental reassurance, modification of feeding and symptom mitigation, monitoring, and referral to paediatricians if warning signs are present. Published clinical practice guidelines (CPGs) seek to support clinicians and improve management. This study aimed to measure the proportion of Australian GOR/GORD paediatric care that was in line with CPG recommendations. National and international CPGs for GOR/GORD were systematically identified and candidate indicators extracted; a Delphi process selected 32 indicators relevant to Australian paediatric care in 2012 and 2013. Medical records were identified in General Practices, the offices of general paediatricians, Emergency Departments and inpatient settings. Adherence to indicators was assessed by nine trained paediatric nurses undertaking retrospective medical record review. Medical records were reviewed in 115 healthcare sites; identifying 285 children, three-quarters aged < 1 year, who had 359 visits for management of GOR/GORD; 2250 eligible indicator assessments were performed. Estimated adherence rates are reported for 21 indicators with ≥ 25 assessments. Five indicators recommending differential diagnostic tests (e.g., urinalysis) for infants presenting with recurrent regurgitation and poor weight gain had ~ 10% adherence; conversely, avoidance of unrecommended tests (e.g., barium swallow and meal) was high (99.8% adherence: 95% CI 97.0-100). Avoidance of prescription of acid-suppression medication for infants at the first presentation was higher if they were healthy and thriving (86.9% adherence: 95% CI 86.0-96.8), intermediate if they had feeding refusal (73.1%: 95% CI 56.0-86.3) and lower if they presented with irritability and unexplained crying (58.8%: 95% CI 28.2-85.0). A guideline targeting Australian health professionals caring for infants and children with GOR/GORD is warranted, highlighting the importance of differential diagnostic testing and avoidance of acid-suppression medication in infants.
胃食管反流（GOR）是婴儿和幼儿的一种常见生理状态，其病理性表现为胃食管反流病（GORD）。GOR/GORD 的管理需要消除可能的潜在原因、让父母安心、调整喂养方式和缓解症状、监测，并在出现警告信号时转介给儿科医生。已发表的临床实践指南（CPG）旨在为临床医生提供支持并改善管理。本研究旨在衡量澳大利亚 GOR/GORD 儿科护理符合 CPG 建议的比例。系统地确定了国内外 GOR/GORD 的 CPG，并提取了候选指标；德尔菲（Delphi）流程于 2012 年和 2013 年选择了 32 个与澳大利亚儿科护理相关的指标。在普通诊所、普通儿科医生办公室、急诊室和住院病房中确定了医疗记录。九名经过培训的儿科护士通过回顾性病历审查来评估指标的依从性。在 115 个医疗保健场所审查了医疗记录；确定了 285 名儿童，其中 3/4 年龄 < 1 岁，他们因 GOR/GORD 管理而进行了 359 次就诊；对 2250 个合格的指标评估进行了评估。报告了有 ≥ 25 次评估的 21 个指标的估计依从率。对于推荐对反复反流和体重增长不良的婴儿进行差异诊断测试（例如尿检）的五项指标，其依从率约为 10%；相反，避免不推荐的测试（例如钡餐和膳食）的依从率很高（99.8%：95%CI 97.0-100）。如果首次就诊的婴儿健康且茁壮成长，避免开具抑酸药物的依从率更高（86.9%：95%CI 86.0-96.8），如果他们有喂养拒绝的情况，依从率为中等（73.1%：95%CI 56.0-86.3），如果他们出现烦躁和不明原因哭泣的情况，依从率更低（58.8%：95%CI 28.2-85.0）。需要为澳大利亚的卫生专业人员制定针对患有 GOR/GORD 的婴儿和儿童的指南，强调差异化诊断测试和避免在婴儿中使用抑酸药物的重要性。
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