AAP Bronchiolitis Guidelines a Mismatch with Clinical Practice
I recently met with a group from our children's hospital to standardize the hospital management of bronchiolitis according to the latest American Academy of Pediatrics guidelines. (Pediatrics 2014;134:e1474; http://bit.ly/2QIGbMX.) Unfortunately, these guidelines seem to cause confusion for experienced and inexperienced emergency physicians alike.This confusion comes from the guidelines raising unaddressed issues and new questions, most importantly not tackling important aspects of frontline clinical practice. These guidelines were developed with the best evidence currently available, and their application mostly causes confusion with our undifferentiated patients. In fact, the guidelines may potentially create unnecessary vulnerabilities in our clinical practice by minimalizing our approach to these wheezing infants. Clinical evaluations, workups, and treatments seem to be discouraged.Diagnosis under the AAP Guidelines1a. Clinicians should diagnose bronchiolitis and assess disease severity based on history and physical examination. (Evidence Quality: B; Recommendation Strength: Strong Recommendation.)1b. Clinicians should assess risk factors for severe disease, such as age under 12 weeks, a history of prematurity, underlying cardiopulmonary disease, or immunodeficiency, when making decisions about the evaluation and management of children with bronchiolitis. (Evidence Quality: B; Recommendation Strength: Moderate Recommendation.)1c. Radiographic...
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