Assessing the appropriateness of the management of gastro-oesophageal reflux in Australian children: a population-based sample survey

Abstract Gastro-oesophageal reflux (GOR) is a common physiological state in infants and young children, with gastro-oesophageal reflux disease (GORD) its pathological manifestation. Management of GOR/GORD requires elimination of possible underlying causes, parental reassurance, modification of feedi...

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Autores principales:	Gaston Arnolda, Harriet Hiscock, David Moore, Glen Farrow, Peter D. Hibbert, Louise K. Wiles, Hseun P. Ting, Charlotte J. Molloy, Meagan Warwick, Jeffrey Braithwaite
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/a0b157b4ba3d4182b858cfb2eab81d26
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spelling	oai:doaj.org-article:a0b157b4ba3d4182b858cfb2eab81d262021-12-02T14:22:43ZAssessing the appropriateness of the management of gastro-oesophageal reflux in Australian children: a population-based sample survey10.1038/s41598-021-87369-72045-2322https://doaj.org/article/a0b157b4ba3d4182b858cfb2eab81d262021-04-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-87369-7https://doaj.org/toc/2045-2322Abstract Gastro-oesophageal reflux (GOR) is a common physiological state in infants and young children, with gastro-oesophageal reflux disease (GORD) its pathological manifestation. Management of GOR/GORD requires elimination of possible underlying causes, parental reassurance, modification of feeding and symptom mitigation, monitoring, and referral to paediatricians if warning signs are present. Published clinical practice guidelines (CPGs) seek to support clinicians and improve management. This study aimed to measure the proportion of Australian GOR/GORD paediatric care that was in line with CPG recommendations. National and international CPGs for GOR/GORD were systematically identified and candidate indicators extracted; a Delphi process selected 32 indicators relevant to Australian paediatric care in 2012 and 2013. Medical records were identified in General Practices, the offices of general paediatricians, Emergency Departments and inpatient settings. Adherence to indicators was assessed by nine trained paediatric nurses undertaking retrospective medical record review. Medical records were reviewed in 115 healthcare sites; identifying 285 children, three-quarters aged < 1 year, who had 359 visits for management of GOR/GORD; 2250 eligible indicator assessments were performed. Estimated adherence rates are reported for 21 indicators with ≥ 25 assessments. Five indicators recommending differential diagnostic tests (e.g., urinalysis) for infants presenting with recurrent regurgitation and poor weight gain had ~ 10% adherence; conversely, avoidance of unrecommended tests (e.g., barium swallow and meal) was high (99.8% adherence: 95% CI 97.0–100). Avoidance of prescription of acid-suppression medication for infants at the first presentation was higher if they were healthy and thriving (86.9% adherence: 95% CI 86.0–96.8), intermediate if they had feeding refusal (73.1%: 95% CI 56.0–86.3) and lower if they presented with irritability and unexplained crying (58.8%: 95% CI 28.2–85.0). A guideline targeting Australian health professionals caring for infants and children with GOR/GORD is warranted, highlighting the importance of differential diagnostic testing and avoidance of acid-suppression medication in infants.Gaston ArnoldaHarriet HiscockDavid MooreGlen FarrowPeter D. HibbertLouise K. WilesHseun P. TingCharlotte J. MolloyMeagan WarwickJeffrey BraithwaiteNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-9 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Gaston Arnolda Harriet Hiscock David Moore Glen Farrow Peter D. Hibbert Louise K. Wiles Hseun P. Ting Charlotte J. Molloy Meagan Warwick Jeffrey Braithwaite Assessing the appropriateness of the management of gastro-oesophageal reflux in Australian children: a population-based sample survey
description	Abstract Gastro-oesophageal reflux (GOR) is a common physiological state in infants and young children, with gastro-oesophageal reflux disease (GORD) its pathological manifestation. Management of GOR/GORD requires elimination of possible underlying causes, parental reassurance, modification of feeding and symptom mitigation, monitoring, and referral to paediatricians if warning signs are present. Published clinical practice guidelines (CPGs) seek to support clinicians and improve management. This study aimed to measure the proportion of Australian GOR/GORD paediatric care that was in line with CPG recommendations. National and international CPGs for GOR/GORD were systematically identified and candidate indicators extracted; a Delphi process selected 32 indicators relevant to Australian paediatric care in 2012 and 2013. Medical records were identified in General Practices, the offices of general paediatricians, Emergency Departments and inpatient settings. Adherence to indicators was assessed by nine trained paediatric nurses undertaking retrospective medical record review. Medical records were reviewed in 115 healthcare sites; identifying 285 children, three-quarters aged < 1 year, who had 359 visits for management of GOR/GORD; 2250 eligible indicator assessments were performed. Estimated adherence rates are reported for 21 indicators with ≥ 25 assessments. Five indicators recommending differential diagnostic tests (e.g., urinalysis) for infants presenting with recurrent regurgitation and poor weight gain had ~ 10% adherence; conversely, avoidance of unrecommended tests (e.g., barium swallow and meal) was high (99.8% adherence: 95% CI 97.0–100). Avoidance of prescription of acid-suppression medication for infants at the first presentation was higher if they were healthy and thriving (86.9% adherence: 95% CI 86.0–96.8), intermediate if they had feeding refusal (73.1%: 95% CI 56.0–86.3) and lower if they presented with irritability and unexplained crying (58.8%: 95% CI 28.2–85.0). A guideline targeting Australian health professionals caring for infants and children with GOR/GORD is warranted, highlighting the importance of differential diagnostic testing and avoidance of acid-suppression medication in infants.
format	article
author	Gaston Arnolda Harriet Hiscock David Moore Glen Farrow Peter D. Hibbert Louise K. Wiles Hseun P. Ting Charlotte J. Molloy Meagan Warwick Jeffrey Braithwaite
author_facet	Gaston Arnolda Harriet Hiscock David Moore Glen Farrow Peter D. Hibbert Louise K. Wiles Hseun P. Ting Charlotte J. Molloy Meagan Warwick Jeffrey Braithwaite
author_sort	Gaston Arnolda
title	Assessing the appropriateness of the management of gastro-oesophageal reflux in Australian children: a population-based sample survey
title_short	Assessing the appropriateness of the management of gastro-oesophageal reflux in Australian children: a population-based sample survey
title_full	Assessing the appropriateness of the management of gastro-oesophageal reflux in Australian children: a population-based sample survey
title_fullStr	Assessing the appropriateness of the management of gastro-oesophageal reflux in Australian children: a population-based sample survey
title_full_unstemmed	Assessing the appropriateness of the management of gastro-oesophageal reflux in Australian children: a population-based sample survey
title_sort	assessing the appropriateness of the management of gastro-oesophageal reflux in australian children: a population-based sample survey
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/a0b157b4ba3d4182b858cfb2eab81d26
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Assessing the appropriateness of the management of gastro-oesophageal reflux in Australian children: a population-based sample survey

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