Large Variation in Clinical Practice amongst Pediatricians in Treating Children with Recurrent Abdominal Pain
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose: To evaluate intra- and inter-observer variability and guideline adherence amongst pediatricians in treating children aged between 4 and 18 years referred with recurrent abdominal pain (RAP) without red flags. Methods: The first part of the study is a retrospective single-center cohort study. The diagnostic work-ups of eight pediatricians were compared to the national guidelines. Intra- and interobserver variability were examined by Cramer's V test. Intra-observer variability was defined as the amount of variation within a pediatrician and inter-observer variability as the amount of variation between pediatricians in the application of diagnostic work-up in children with RAP. Prospectively, the same pediatricians were requested to provide a report on their management strategy with a fictitious case to prove similarities in retrospective diagnostic work-up. Results: A total of 10 patients per pediatrician were analyzed. Retrospectively, a (very) weak association between pediatricians' diagnostic work-ups was found (0.22), which implies high inter-observer variability. The association between intra-observer diagnostic was moderate (range, 0.35–0.46). The Cramer's V of 0.60 in diagnostic work-up between pediatricians in the fictitious case implied the presence of a moderately strong association and lower interobserver variability than in the retrospective study. Adherence to the guideline was 66.8%. Conclusion: We found a high intra- and inter-observer variability and moderate guideline adherence in daily clinical practice amongst pediatricians in treating children with RAP in a teaching hospital.
Abstract
Purpose: To evaluate intra- and inter-observer variability and guideline adherence amongst pediatricians in treating children aged between 4 and 18 years referred with recurrent abdominal pain (RAP) without red flags. Methods: The first part of the study is a retrospective single-center cohort study. The diagnostic work-ups of eight pediatricians were compared to the national guidelines. Intra- and interobserver variability were examined by Cramer's V test. Intra-observer variability was defined as the amount of variation within a pediatrician and inter-observer variability as the amount of variation between pediatricians in the application of diagnostic work-up in children with RAP. Prospectively, the same pediatricians were requested to provide a report on their management strategy with a fictitious case to prove similarities in retrospective diagnostic work-up. Results: A total of 10 patients per pediatrician were analyzed. Retrospectively, a (very) weak association between pediatricians' diagnostic work-ups was found (0.22), which implies high inter-observer variability. The association between intra-observer diagnostic was moderate (range, 0.35–0.46). The Cramer's V of 0.60 in diagnostic work-up between pediatricians in the fictitious case implied the presence of a moderately strong association and lower interobserver variability than in the retrospective study. Adherence to the guideline was 66.8%. Conclusion: We found a high intra- and inter-observer variability and moderate guideline adherence in daily clinical practice amongst pediatricians in treating children with RAP in a teaching hospital.
참고문헌 (18)
- Baber KF, "Rome II versus Rome III classification of functional gastrointestinal disorders in pediatric chronic abdominal pain", J Pediatr Gastroenterol Nutr, 47, pp.299~302 (2008)
- Hyams JS, "Childhood functional gastrointestinal disorders : child", adolescent, 2016, pp.150, 1456~1468.e2
- Di Lorenzo C, "Chronic abdominal pain in children: a technical report of the American Academy of Pediatrics and the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition", J Pediatr Gastroenterol Nutr, 40, pp.249~261 (2005)
- Wright NJ, "Chronic abdominal pain in children : help in spotting the organic diagnosis", Arch Dis Child Educ Pract Ed, 98, pp.32~39 (2013)
- Rajindrajith S, "Functional abdominal pain disorders in children", Expert Rev Gastroenterol Hepatol, 12, pp.369~390 (2018)
- Yacob D, "How to deal with pediatric functional gastrointestinal disorders", Curr Pediatr Rep, 1, pp.198~205 (2013)
- Christakis DA, "Variation in inpatient diagnostic testing and management of bronchiolitis", Pediatrics, 115, pp.878~884 (2005)
- Florin TA, "Variation in emergency department diagnostic testing and disposition outcomes in pneumonia", Pediatrics, 132, pp.237~244 (2013)
- Urkin J, "Acute pharyngitis : low adherence to guidelines highlights need for greater flexibility in managing paediatric cases", Acta Paediatr, 02, pp.1075~1080 (2013)
- Niele N, "National survey on managing minor childhood traumatic head injuries in the Netherlands shows low guideline adherence and large interhospital variations", Acta Paediatr, 107, pp.168~169 (2018)
- Lugtenberg M, "Why don't physicians adhere to guideline recommendations in practice? An analysis of barriers among Dutch general practitioners", Implement Sci, 4, pp.54~ (2009)
- Halm EA, "Understanding physician adherence with a pneumonia practice guideline : effects of patient, system, and physician factors", Arch Intern Med, 160, pp.98~104 (2000)
- Cnossen MC, "Adherence to guidelines in adult patients with traumatic brain injury : a living systematic review", J Neurotrauma, 33, pp.1~14 (2016)
- Jansen PR, "Incidental findings on brain imaging in the general pediatric population", N Engl J Med, 377, pp.1593~1595 (2017)
- Paul R, "Improving adherence to PALS septic shock guidelines", Pediatrics, 133, pp.e1358~66 (2014)
- Nicastro E, "The impact of e-learning on adherence to guidelines for acute gastroenteritis : a single-arm intervention study", PLoS One, 10, pp.e0132213~ (2015)
- Redaèlli M, "Guideline implementation study on asthma : results of a pragmatic implementation approach", Z Evid Fortbild Qual Gesundhwes, 109, pp.124~131 (2015)
- Maas L, "Detection of intestinal protozoa in paediatric patients with gastrointestinal symptoms by multiplex real-time PCR", Clin Microbiol Infect, 20, pp.545~550 (2014)