儿童哮吼临床实践组织指南的差异。

Variation in Organizational Clinical Practice Guidelines for Croup.

机构信息

Departments of Pediatric Emergency Medicine.

Value and Clinical Excellence, Children's Minnesota, Minneapolis Minnesota.

出版信息

Hosp Pediatr. 2023 Sep 1;13(9):e241-e245. doi: 10.1542/hpeds.2023-007221.

DOI:10.1542/hpeds.2023-007221

PMID:37545472

Abstract

BACKGROUND

Croup is one of the most common respiratory complaints in pediatric emergency departments (EDs), yet little is known about clinical practice guidelines (CPGs) for this condition.

OBJECTIVES

To describe variation in CPGs across US children's hospitals.

METHODS

We describe the prevalence and features of CPGs among hospitals that submit data to the Pediatric Health Information System. Each hospital was contacted between January 10, 2022, and April 25, 2022, for their most recent croup CPG and any revisions. Characteristics reported were based on the most recent CPG revision. Characteristics included treatment recommendations, utilization measures, ED observation times, and admission criteria. Interrater reliability between reviewers was reported as percentage agreement.

RESULTS

Thirty-eight hospitals (79.2%) responded to our query, of which 20 (52.6%) had croup CPGs. Interrater reliability was moderate-high for categorizing the indication for racemic epinephrine (RE) (19 of 20; 95%), the minimum number of RE doses recommended before admission (15 of 20; 75%), and ED observation time (19 of 20; 95%), and was 100% for all other characteristics. Three CPGs (15.0%) recommended 1 RE dose, 14 (70.0%) recommended 2 RE doses, and 3 (15.0%) recommended 3 RE doses before hospital admission. Thirteen (65%) CPGs recommended RE for stridor at rest, whereas 7 (30%) recommended RE for any degree of stridor. Fourteen (70%) CPGs recommended an ED observation time <2 hours, 3 (15%) recommended 2 to 4 hours, and 2 (10%) recommended >4 hours. Few CPGs (15%) recommended use of standardized croup clinical scores.

CONCLUSIONS

Substantial variation exists among croup CPGs. Our results may inform future efforts to standardize croup CPGs across centers.

摘要

背景

哮吼是儿科急诊部门（ED）最常见的呼吸道疾病之一，但对于该疾病的临床实践指南（CPG）知之甚少。

目的

描述美国儿童医院之间 CPG 的差异。

方法

我们描述了向儿科健康信息系统提交数据的医院中 CPG 的流行情况和特征。每个医院都在 2022 年 1 月 10 日至 2022 年 4 月 25 日之间联系，以获取他们最近的哮吼 CPG 及其任何修订版。报告的特征基于最近的 CPG 修订版。特征包括治疗建议、使用措施、ED 观察时间和入院标准。两位审阅者之间的评分者间可靠性以百分比一致表示。

结果

38 家医院（79.2%）对我们的查询做出了回应，其中 20 家（52.6%）有哮吼 CPG。对于分类使用 Racemic Epinephrine（RE）的指征（20 次中有 19 次，95%）、推荐的入院前 RE 剂量最低数（20 次中有 15 次，75%）和 ED 观察时间（20 次中有 19 次，95%）的分类，评分者间可靠性为中度-高度，而对于所有其他特征，评分者间可靠性为 100%。3 份 CPG（15.0%）建议 1 次 RE 剂量，14 份（70.0%）建议 2 次 RE 剂量，3 份（15.0%）建议 3 次 RE 剂量。13 份（65%）CPG 建议在静息时出现喘鸣时使用 RE，而 7 份（30%）建议在任何程度的喘鸣时使用 RE。14 份（70%）CPG 建议 ED 观察时间<2 小时，3 份（15%）建议 2 至 4 小时，2 份（10%）建议>4 小时。很少有 CPG（15%）建议使用标准化的哮吼临床评分。