Project snapshot – Development of the Australasian Bronchiolitis clinical practice guideline.

Bronchiolitis is the commonest lower respiratory tract infection in children less than 12 months and is the most frequent cause of hospitalisation in infants under 6 months of age in Australasia.  Research conducted by the PREDICT identified substantial variation in practice patterns in the management of bronchiolitis, despite high levels of evidence supporting some areas of treatment.

To improve consistency of Australasian practice, an evidence based consensus led guideline for the management of bronchiolitis in infants presenting to, and admitted into hospitals was developed. This guideline represents the first high quality acute paediatric care guideline to be developed across both countries.

A Guideline Advisory Group was formed which consisted of the project chief investigators; three paediatric emergency physicians, one paediatrician and the project coordinator.  The role of this group was to provide expert advice and contribute to the guideline development process including construction of population, intervention, comparator, outcomes and time of interest (PICOt) questions, defining the guideline scope and target audience, and oversight of the project.

A multidisciplinary Guideline Development Committee which included the members of the Guideline Advisory Group, was convened in accordance with the NHMRC recommendations for guideline development.  This committee comprised of twenty-two individuals, including;  eight General Paediatricians, one Paediatric Respiratory Physician, eight Paediatric Emergency Medicine Physicians, one Paediatric Intensive Care Physician , one Paediatric Nurse Practitioner, two Paediatric Nurses, and one Paediatric Emergency Nurse from a mixture of Australian and New Zealand metropolitan and non-metropolitan centres, (including representatives from six of the eight Australian States and Territories).  The Australian and New Zealand Paediatric Societies were also approached seeking their representation for the Guideline Development Committee.  This committee was established to review and synthesise the evidence to prepare the evidence based guideline, ensuring relevance to their specific speciality areas of representation.

The nine step process recommended by the National Health and Medical Research Council (NHMRC) and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology were adapted.  Formulation of the guideline included identification of PICOt questions, a systematic literature search, grading of evidence using the NHMRC process and GRADE methodology.  The GRADE and NHMRC processes provided a systematic and transparent approach, ensuring a final structure that includes a useable clinical interface for bedside use and a descriptive summary of the evidence base and evidence tables for each key statement.

Consensus with the Development Committee was sought using nominal group technique principles to formulate the clinical recommendations and practice points.  The final step was consultation and review by key paediatric health professional bodies seeking endorsement to ensure the guideline was relevant to the management of bronchiolitis in the Australasian emergency and ward settings.

The Guideline is currently in the final stages of review and will be made available for use in the next few months.