Adherence to Clinical Practice Guidelines for Treatment of Bell's Palsy.

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.