Bell's palsy in children: Current treatment patterns in Australia and New Zealand. A PREDICT study.
OBJECTIVE
The aetiology and clinical course of Bell's palsy may be different in paediatric and adult patients. There is no randomised placebo controlled trial (RCT) to show effectiveness of prednisolone for Bell's palsy in children. The aim of the study was to assess current practice in paediatric Bell's palsy in Australia and New Zealand Emergency Departments (ED) and determine the feasibility of conducting a multicentre RCT within the Paediatric Research in Emergency Departments International Collaborative (PREDICT).


METHODS
A retrospective analysis of ED medical records of children less than 18 years diagnosed with Bell's palsy between 1 January, 2012 and 31 December, 2013 was performed. Potential participants were identified from ED information systems using Bell's palsy related search terms. Repeat presentations during the same illness were excluded but relapses were not. Data on presentation, diagnosis and management were entered into an online data base (REDCap).


RESULTS
Three hundred and twenty-three presentations were included from 14 PREDICT sites. Mean age at presentation was 9.0 (SD 5.0) years with 184 (57.0%) females. Most (238, 73.7%) presented to ED within 72 h of symptoms, 168 (52.0%) had seen a doctor prior. In ED, 218 (67.5%) were treated with steroids. Prednisolone was usually prescribed for 9 days at around 1 mg/kg/day, with tapering in 35.7%.


CONCLUSIONS
Treatment of Bell's palsy in children presenting to Australasian EDs is varied. Prednisolone is commonly used in Australasian EDs, despite lack of high-level paediatric evidence. The study findings confirm the feasibility of an RCT of prednisolone for Bell's palsy in children.
Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia.|Clinical Sciences Theme, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.|Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.
Franz E
FE
Babl
Clinical Sciences Theme, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
Kaya K
KK
Gardiner
Emergency Department, Women's and Children's Hospital, Adelaide, South Australia, Australia.
Amit
A
Kochar
Clinical Sciences Theme, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
Catherine L
CL
Wilson
Emergency Department, Gold Coast University Hospital, School of Medicine, Griffith University, Gold Coast, Townsville, Queensland, Australia.
Shane A
SA
George
Emergency Department, John Hunter Hospital, Newcastle, New South Wales, Australia.
Michael
M
Zhang
Emergency Department, Townsville Hospital and James Cook University College of Medicine and Dentistry, Townsville, Queensland, Australia.
Jeremy
J
Furyk
Emergency Department, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
Deepali
D
Thosar
Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia.|Clinical Sciences Theme, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.|Emergency Department, Monash Medical Centre, Melbourne, Victoria, Australia.
John A
http://orcid.org/0000-0002-3615-3821
JA
Cheek
Emergency Department, Sunshine Hospital, Melbourne, Victoria, Australia.
David
http://orcid.org/0000-0002-7173-6993
D
Krieser
Emergency Department, Sydney Children's Hospital, Sydney, New South Wales, Australia.
Arjun S
AS
Rao
Emergency Department, Princess Margaret Hospital for Children, Perth, Western Australia, Australia.|Schools of Paediatric and Child Health and Primary, Aboriginal and Rural Health Care, University of Western Australia, Perth, Western Australia, Australia.
Meredith L
ML
Borland
Emergency Department, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
Nicholas
N
Cheng
Emergency Department, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia.
Natalie T
NT
Phillips
Emergency Department, Canberra Hospital, Canberra, Australian Capital Territory, Australia.
Kam K
KK
Sinn
Emergency Department, KidzFirst Middlemore Hospital, Auckland, New Zealand.|Liggins Institute, University of Auckland, Auckland, New Zealand.
Jocelyn M
JM
Neutze
Liggins Institute, University of Auckland, Auckland, New Zealand.|Emergency Department, Starship Children's Hospital, Auckland, New Zealand.
Stuart R
SR
Dalziel
D000293:Adolescent; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001315:Australia; D020330:Bell Palsy / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D008485:Medical Audit; D009520:New Zealand; D010818:Practice Patterns, Physicians'; D011239:Prednisolone / Q000627:therapeutic use; D012189:Retrospective Studies; D013256:Steroids / Q000627:therapeutic use
D000893:Anti-Inflammatory Agents; D013256:Steroids; D011239:Prednisolone
Bell's palsy; child; facial palsy; prednisolone