Challenges in Implementing Evidence-Based Guidelines for Acute Pediatric Dyspnea: The Experience of El Alaa District Hospital

Abstract

Abstract : Background: Acute dyspnea is a leading cause of pediatric emergency consultations. This study aims to describe the epidemiological, clinical, and therapeutic aspects of acute dyspnea in a Tunisian district hospital. Methods: A descriptive cross-sectional study was conducted at El Alaa District Hospital in Kairouan,Tunisia from January to June 2025, including 52 children under 15 years presenting with acute dyspnea. Results: The mean age was 3.8 years, with a male predominance (75%). Asthma (50.9%), bronchiolitis (29.4%), and laryngitis (19.6%) were the primary diagnoses. Management included bronchodilators for all asthma cases and nebulized adrenaline for all laryngitis cases. Regarding bronchiolitis, management showed significant variations from national guidelines: while nasopharyngeal suctioning was perfomed only to 66.6% of cases, corticosteroids were administered to 46.7% of infants, and antibiotic therapy was initiated in 33.3%, despite the absence of documented bacterial coinfection. Bronchodilators were also used in 40% of bronchiolitis cases. Overall, clinical improvement was achieved in 73.1% of the total cohort, while 26.9% required transfer to a specialized pediatric ward. No deaths were recorded. Conclusion: Acute dyspnea in this setting is mainly due to asthma and bronchiolitis. While most cases are managed successfully at the district level, standardized protocols and caregiver education remain essential.