Examining Agreement and Variability among National and International Guideline Treatment Recommendations for Asthma and Bronchiolitis

Background: There may be variability in guideline recommendations for a condition.;Objective: To determine variability among asthma and bronchiolitis recommendations and related factors.;Design/Methods: Kappa, guideline variability index (GVI), and univariable and multiple linear regression analyses were performed.;Results: The overall kappa for asthma was 0.03 unweighted and weighted ((95% CI, -0.01, 0.07)(95% CI, -0.01, 0.10)) and bronchiolitis was unweighted 0.32 (95% CI, 0.16, 0.52) and weighted 0.15 (95% CI, -0.01, 0.5). The mean [SD] asthma GVI was 1.7 [0.48] and bronchiolitis was 1.17 [0.92]. Using a multivariable linear regression, mean level of evidence (0.54 (95% CI, 0.0, 1.09)) and mean strength of recommendation (-0.68 (95% CI, -1.30, -0.07)) were significantly associated with variability among asthma guidelines.;Conclusions: There was variability among guideline treatment recommendations. Mean level of evidence and mean strength of recommendation significantly contributed to variation in guideline recommendations for asthma but not for bronchiolitis.