Prioritising Recommendations for Conversion to Living Mode in the Australasian Bronchiolitis Guideline: A Modified Delphi Study

Abstract

Background

The Australasian Bronchiolitis Guideline (ABG) provides evidence-based recommendations for managing one of the most frequent reasons for infant hospitalisation. As traditional guidelines age, they suffer from lack of relevance when new evidence is available but not incorporated. To address this limitation a guideline, or parts thereof, can be converted into a “living” mode, where new evidence is regularly incorporated into recommendations, enabling faster translation to practice. This study aimed to prioritise ABG recommendations for conversion to a living mode.

Method

Members of the 2025 ABG Guideline Advisory Group and Guideline Development Committee were invited to participate in an online, modified Delphi study. Panellists ranked 38 recommendations as low, medium, or high priority for conversion to a living mode across two rounds. A consensus threshold of ≥ 75% agreement was used. Data collection ceased once consensus was reached on ≥ 4 recommendations for conversion.

Results

Twenty-five of 29 (86%) experts responded in round one and 20/25 (80%) in round two. Panel diversity was maintained throughout voting rounds. At round one, consensus was reached to convert three recommendations to a living format and 11/38 recommendations were excluded. At round two, one additional recommendation was prioritised for conversion and 16/24 were excluded. Consensus was not reached on seven recommendations.

Conclusion

Four key management recommendations will be converted to a living mode: high-flow therapy, combined glucocorticoid/adrenaline therapy, oxygen saturation targets, and chest X-ray in intensive care settings. These recommendations will be regularly updated as new evidence becomes available, supporting a more rapid translation to clinical practice.