In recent years, considerable effort has been put into development of clinical guidelines by national organizations. In this issue of The Journal, two audits of adherence to such guidelines are reported.In the first, Bratton and colleagues evaluated recent variations in intensive care for pediatric patients with asthma. They studied a cohort of children treated for asthma in pediatric intensive care units during the period of 2000-2003. The study addresses the question of what supplementary therapies were added when patients did not improve with standard therapy of inhaled β-agonists and systemic corticoids. Addition of inhaled anticholinergics therapy is recommended in the “Global Initiative for Asthma” endorsed by the World Health Organization and the National Institutes of Health; however, only 59% of 7,125 children received this additional therapy. A large number of other therapies were added in the study including intravenous magnesium sulfate, methylxanthines, and inhaled helium oxygen gas mixtures and there was considerable regional variation in the approaches. The authors conclude that adherence to national guidelines for use of inhaled anticholinergics among children with asthma is low, and more explicit guidelines might improve asthma care.In the second article, Sox et al studied pediatricians' practice of routine screening urinalysis. They sampled 1,502 pediatricians of whom 653 responded to a questionnaire. The pediatrician's practice was compared to that recommended by the American Academy of Pediatrics. Results showed that, while the majority of pediatricians are routinely screening asymptomatic children with urinalysis at least sometime during childhood, the age of screening varied considerably and did not follow the current recommendations of the AAP to screen 5-year-old children and sexually active adolescents.Further research will be needed to understand the benefits of clinical practice guidelines and how to introduce them most effectively. In recent years, considerable effort has been put into development of clinical guidelines by national organizations. In this issue of The Journal, two audits of adherence to such guidelines are reported. In the first, Bratton and colleagues evaluated recent variations in intensive care for pediatric patients with asthma. They studied a cohort of children treated for asthma in pediatric intensive care units during the period of 2000-2003. The study addresses the question of what supplementary therapies were added when patients did not improve with standard therapy of inhaled β-agonists and systemic corticoids. Addition of inhaled anticholinergics therapy is recommended in the “Global Initiative for Asthma” endorsed by the World Health Organization and the National Institutes of Health; however, only 59% of 7,125 children received this additional therapy. A large number of other therapies were added in the study including intravenous magnesium sulfate, methylxanthines, and inhaled helium oxygen gas mixtures and there was considerable regional variation in the approaches. The authors conclude that adherence to national guidelines for use of inhaled anticholinergics among children with asthma is low, and more explicit guidelines might improve asthma care. In the second article, Sox et al studied pediatricians' practice of routine screening urinalysis. They sampled 1,502 pediatricians of whom 653 responded to a questionnaire. The pediatrician's practice was compared to that recommended by the American Academy of Pediatrics. Results showed that, while the majority of pediatricians are routinely screening asymptomatic children with urinalysis at least sometime during childhood, the age of screening varied considerably and did not follow the current recommendations of the AAP to screen 5-year-old children and sexually active adolescents. Further research will be needed to understand the benefits of clinical practice guidelines and how to introduce them most effectively.
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Oct 29, 2024
Louis Akiyama + 3
Open Access