Abstract：
BACKGROUND: Bell\'s palsy is the most common cause of acute facial nerve paresis and paralysis with devastating disability yet high rate of spontaneous recovery. Patients who do not fully recover have functional disability that may require reconstructive surgery. The Clinical Practice Guideline: Bell\'s Palsy recommends treatment with high-dose steroids as it shows a higher likelihood of complete recovery. However, guideline adherence rates are inconsistent and unstudied.
OBJECTIVE: To identify the frequency at which hospital-based clinicians at the University of Wisconsin-Madison follow recommended clinical guidelines and prescribe high-dose steroid medication.
METHODS: Charts were reviewed from a single hospital (University Hospital) to evaluate Bell\'s palsy guideline adherence. All hospital-based encounters from 2008 through 2018 with primary diagnosis of Bell\'s palsy (ICD-9 351.0 and ICD-10 G51.0) were identified. Encounters were excluded if they had a diagnosis of Bell\'s palsy within 1 year prior (n=250) and did not have a medication list available (n=353). We examined patient demographics, common comorbidities, and any radiology and lab orders.
RESULTS: We identified 565 patients with a primary diagnosis of Bell\'s palsy with available medication lists; 77.70% received the recommended treatment. The patients\' median age was 47 (interquartile range 34-59), 52.16% were male, and 82.46% were treated by emergency medicine clinicians. Other treating clinicians were hospital-based primary care, otolaryngology and plastic surgery, and others. Multivariate analysis showed that treating clinician specialty was the only significant positive predictor.
CONCLUSIONS: A significant portion of clinicians followed treatment guidelines for Bell\'s palsy. Further and larger research is needed to better identify points of intervention to improve guideline adherence.
OBJECTIVE: To identify the frequency at which hospital-based clinicians at the University of Wisconsin-Madison follow recommended clinical guidelines and prescribe high-dose steroid medication.
METHODS: Charts were reviewed from a single hospital (University Hospital) to evaluate Bell\'s palsy guideline adherence. All hospital-based encounters from 2008 through 2018 with primary diagnosis of Bell\'s palsy (ICD-9 351.0 and ICD-10 G51.0) were identified. Encounters were excluded if they had a diagnosis of Bell\'s palsy within 1 year prior (n=250) and did not have a medication list available (n=353). We examined patient demographics, common comorbidities, and any radiology and lab orders.
RESULTS: We identified 565 patients with a primary diagnosis of Bell\'s palsy with available medication lists; 77.70% received the recommended treatment. The patients\' median age was 47 (interquartile range 34-59), 52.16% were male, and 82.46% were treated by emergency medicine clinicians. Other treating clinicians were hospital-based primary care, otolaryngology and plastic surgery, and others. Multivariate analysis showed that treating clinician specialty was the only significant positive predictor.
CONCLUSIONS: A significant portion of clinicians followed treatment guidelines for Bell\'s palsy. Further and larger research is needed to better identify points of intervention to improve guideline adherence.
摘要：
背景：贝尔麻痹是急性面神经麻痹和瘫痪的最常见原因，具有毁灭性残疾，但自发恢复率高。未完全康复的患者有可能需要进行重建手术的功能障碍。临床实践指南：贝尔氏麻痹建议使用高剂量类固醇治疗，因为它显示完全康复的可能性更高。然而,指南依从率不一致且未经研究。
目的：确定威斯康辛大学麦迪逊分校的医院临床医生遵循推荐的临床指南并开出高剂量类固醇药物的频率。
方法：对来自一家医院（大学医院）的图表进行审查，以评估贝尔麻痹指南的依从性。确定了从2008年到2018年所有以医院为基础的初次诊断为贝尔麻痹（ICD-9351.0和ICD-10G51.0）的患者。如果他们在1年前被诊断为贝尔麻痹（n=250）并且没有可用的药物清单（n=353），则将其排除在外。我们检查了病人的人口统计学,常见的合并症，以及任何放射科和实验室命令。
结果：我们确定了565例主要诊断为贝尔麻痹的患者，并提供了可用的药物清单；77.70%接受了推荐的治疗。患者的中位年龄为47岁(四分位距34-59岁)，52.16%为男性，82.46%由急诊医学临床医生治疗。其他治疗的临床医生是以医院为基础的初级保健，耳鼻喉科和整形外科,和其他人。多因素分析表明，治疗临床医师专业是唯一有意义的阳性预测因素。
结论：相当一部分临床医生遵循贝尔麻痹的治疗指南。需要进一步和更大的研究来更好地确定干预点，以提高指南的依从性。
目的：确定威斯康辛大学麦迪逊分校的医院临床医生遵循推荐的临床指南并开出高剂量类固醇药物的频率。
方法：对来自一家医院（大学医院）的图表进行审查，以评估贝尔麻痹指南的依从性。确定了从2008年到2018年所有以医院为基础的初次诊断为贝尔麻痹（ICD-9351.0和ICD-10G51.0）的患者。如果他们在1年前被诊断为贝尔麻痹（n=250）并且没有可用的药物清单（n=353），则将其排除在外。我们检查了病人的人口统计学,常见的合并症，以及任何放射科和实验室命令。
结果：我们确定了565例主要诊断为贝尔麻痹的患者，并提供了可用的药物清单；77.70%接受了推荐的治疗。患者的中位年龄为47岁(四分位距34-59岁)，52.16%为男性，82.46%由急诊医学临床医生治疗。其他治疗的临床医生是以医院为基础的初级保健，耳鼻喉科和整形外科,和其他人。多因素分析表明，治疗临床医师专业是唯一有意义的阳性预测因素。
结论：相当一部分临床医生遵循贝尔麻痹的治疗指南。需要进一步和更大的研究来更好地确定干预点，以提高指南的依从性。
