TABLE 4

Key Recommendations Given by 2 or More Bronchiolitis Guidelines and Primary Outcome of Treatment Recommendation

Strength of evidence for the AAPaAAP 2014SIGN 2006SNHS 2010CPS 2014
AGREE II overall score (out of a possible 7)b5652
Recommendation topics
 Routine use of β agonistsBRecommend againstRecommend againstRecommend againstRecommend against
 Routine use of α agonistsBRecommend againstRecommend againstRecommend againstRecommend against
 Trial of α or β adrenergic medicationDid not addressDid not addressOptionalOptional
 Corticosteroid medications (oral or inhaled)ARecommend againstRecommend againstRecommend againstRecommend against
 Corticosteroids: ventilated patientsARecommend againstDid not addressDid not addressDid not address
 RibavirinDid not addressRecommend againstRecommend againstDid not address
 Antibiotics for bacterial coinfectionBRecommend forDid not addressRecommend forRecommend for
 Antibiotics for bronchiolitisBRecommend againstRecommend againstRecommend againstRecommend against
 Hydration assessment and ability to take oral fluidsDid not addressDid not addressRecommend forRecommend for
 Chest physiotherapyBRecommend againstRecommend againstRecommend againstRecommend against
 Supplemental O2 use <90%DRecommend forRecommend forRecommend forRecommend for
 Supplemental O2 use <92%DOptionalRecommend forRecommend forDid not address
 O2-using continuous pulse-oximetryCOptionalDid not addressDid not addressOptional
 3% hypertonic saline trialBOptionalDid not addressRecommend forOptional
 Hypertonic saline in emergency departmentBRecommend againstDid not addressDid not addressRecommend against
 MontelukastDid not addressAbstainRecommend againstDid not address
 Respiratory secretion aspirationDid not addressRecommend forRecommend forOptional
 Feeds, nasogastricXRecommend forRecommend forOptionalDid not address
 Feeds, intravenous hydrationXRecommend forDid not addressRecommend forRecommend for
 Noninvasive ventilationDid not addressRecommend forRecommend forDid not address
 Invasive ventilationDid not addressRecommend forRecommend forDid not address
  • Key recommendations given by each guideline for comparison on whether a treatment was recommended. AGREE II scoring instrument to assess guideline quality and reporting: overall score reported. The level of evidence is given in letters per the system of evidence reporting in the AAP guideline. —, not available.

  • a The level of evidence is given in letters per the system of evidence reporting in the AAP guideline.22 Evidence Level A: Intervention: well-designed and conducted trials, meta-analyses on applicable populations; Diagnosis: independent gold standard studies of applicable populations. Evidence Level B: trials or diagnostic studies with minor limitations; consistent findings from multiple observational studies. Evidence Level C: single or few observational studies or multiple studies with inconsistent findings or major limitations. Evidence Level D: expert opinion, case reports, reasoning from first principles. Evidence Level X: exceptional situations in which validating studies cannot be performed and there is a clear preponderance of benefit or harm.

  • b AGREE II scoring instrument to assess guideline quality and reporting: this tool has overall guideline assessments (overall score above), as well as 23 individual questions.