Nationwide Adherence to Bell's Palsy Clinical Practice Guidelines: Retrospective Analysis Using a Large-Scale EHR Database.

Abstract

This study aimed to evaluate nationwide adherence to American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) guidelines for Bell's palsy management using a large electronic health record (EHR) database. Retrospective cohort study. U.S. Network in TriNetX. A retrospective cohort study was conducted using the TriNetX global EHR database, identifying patients diagnosed with Bell's palsy (ICD-10 code G51.0) from 2004 to 2024. Data collected included corticosteroid administration within 72 hours of diagnosis, antiviral use (valacyclovir or acyclovir), and the performance of imaging (computed tomography [CT]/magnetic resonance imaging [MRI] of the head or face) or Borrelia burgdorferi serologic testing. Outcomes were compared in cohorts before and after 2013, the year the AAO-HNS guidelines were published. Steroid administration within 72 hours of diagnosis increased significantly after guideline publication, from 4798 (20.4%) patients before 2013 to 78,096 (33.8%) patients after 2013 (P < .001). However, the use of non-recommended practices also increased. Imaging use rose from 32.9% to 41.0% (P < .001), and serologic testing for Borrelia increased from 1% to 5% (P < .001). Antiviral use, considered optional by the guidelines, increased from 11.8% to 23.5% (P < .001) over the same 72-hour time period. Following the publication of the AAO guidelines, early steroid use for Bell's palsy improved significantly. However, the concurrent rise in imaging and laboratory testing-practices explicitly discouraged by the guidelines-highlights ongoing gaps in adherence and suggests areas for further provider education and quality improvement.