LAUSR

Introduction Increasingly, hospitals rely on local clinical practice guidelines (CPGs) alongside national guidance to standardise clinical care. This study examines variation between national and local CPGs, using the example of acute paediatric asthma (APA) CPGs from the United Kingdom and the Netherlands. Methods Fifteen British and Dutch local CPGs were collected with the matching national guidance for the management of APA. The drug sequences, routes and methods of administration recommended for patients with severe APA were represented. Deviations from national guidance were measured. Variation in recommended doses of intravenous salbutamol was examined. CPG quality was assessed using the AGREE II instrument. Results British and Dutch national CPGs differed in the recommended drug choices, sequences, routes and methods of administration for severe APA. Local British CPGs diverged from national guidance for 23% of their recommended interventions compared to 8% for Dutch local CPGs. Variation in second-line recommendations was greater than for first-line recommendations across local CPGs from both countries. Recommended starting doses for salbutamol infusions varied by more than tenfold. The quality of the sampled local CPGs was low across five out of six AGREE domains (<60%). Conclusions Local CPGs for the management of severe APA featured substantial variation and frequently diverged from national guidance. Their methodological quality was low. Although limited to one condition, this study suggests that unmeasured variation across local CPGs may contribute to variation of care more broadly, potentially undermining healthcare quality.