1
|
Zhang S, Wu L, Wang Y, Zhou Q, Luo X, Mathew JL, Wang Q, Song Y, Chen Y. Methodological and reporting quality of pediatric clinical practice guidelines: a systematic review. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1258. [PMID: 34532395 PMCID: PMC8421971 DOI: 10.21037/atm-21-2686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 06/20/2021] [Indexed: 11/25/2022]
Abstract
Background Pediatric clinical practice guidelines (CPGs) can provide systematically developed clinical recommendations to guide pediatric clinicians and patients making decisions. This study aims to assess the methodological and reporting quality of pediatric CPGs. Methods We performed a systematic literature search of MEDLINE from 1 January 1990 to 2 April 2020 to identify pediatric CPGs published in the ten highest-impact pediatric journals and four highest-impact general medical journals. Two researchers evaluated the methodological and reporting quality of pediatric CPGs using the Appraisal of Guidelines Research and Evaluation (AGREE) II instrument and Reporting Items for Practice Guidelines in Health care (RIGHT) checklist. We calculated the mean AGREE II scores and compliance to RIGHT overall, and for each domain of the respective tools. We compared the methodological and reporting quality by different time periods and calculated the correlation between the AGREE II score and compliance to RIGHT. Results A total of 159 pediatric CPGs were identified. The mean (± standard deviation) scores for the six domains of the AGREE II instrument were as follows: scope and purpose 74.5%±14.2%, stakeholder involvement 42.7%±16.2%, rigour of development 18.7%±14.2%, clarity of presentation 56.5%±17.0%, applicability 8.9%±12.7% and editorial independence 25.2%±34.6%. The overall assessment score was 37.8%±12.4%. The mean compliance to RIGHT items in the seven domains of the checklist were: basic information 73.6%±14.9%, background 67.1%±16.4%, evidence 32.7%±27.2%, recommendations 32.4%±22.5%, review and quality assurance 22.9%±40.4%, funding and declaration and management of interests 24.1%±36.3%, and other information 45.3%±30.1%. The overall reporting rate for RIGHT was 46.4%±16.6%. Both the AGREE II scores and RIGHT reporting rates increased over time. We found a high positive correlation between AGREE II scores and RIGHT reporting compliance (r=0.645, P<0.001). Discussion The methodological and reporting quality of pediatric CPGs have improved over time, but remain still suboptimal and needs to be further improved. An international database of pediatric guidelines is urgently needed to identify and promote high-quality guidelines and guide clinical practice in pediatrics.
Collapse
Affiliation(s)
- Shu Zhang
- Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Lei Wu
- Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Yang Wang
- Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Qi Zhou
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, China
| | - Xufei Luo
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Joseph L Mathew
- Advanced Pediatrics Centre, PGIMER Chandigarh, Chandigarh, India
| | - Qi Wang
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster Health Forum, McMaster University, Hamilton, Canada
| | - Yang Song
- Iberoamerica Cochrane Centre, Research Institute, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Yaolong Chen
- National Clinical Research Center for Child Health and Disorders, Evidence-Based Medicine Center, Basic Medical Sciences, Lanzhou University, Lanzhou, China
| |
Collapse
|
2
|
Hough JL, Barton J, Jardine LA. A quality appraisal using the AGREE II instrument of endotracheal tube suction guidelines in neonatal intensive care units. Aust Crit Care 2021; 34:524-529. [PMID: 33752956 DOI: 10.1016/j.aucc.2021.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 01/23/2021] [Accepted: 02/06/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Endotracheal tube (ETT) suction is among the most common procedures performed in neonatal intensive care units (NICUs). Although necessary, it is associated with significant risks. To mitigate these risks, clinical practice guidelines are developed to provide evidence-based recommendations. OBJECTIVE The aim of the study was to appraise the quality of neonatal ETT suction guidelines from all NICUs in Australia and New Zealand. METHODS All level III NICUs in Australia and New Zealand were invited to participate. Three researchers graded the methodological quality of the received guidelines using the AGREE II instrument. Item and domain scores were calculated by scaling as a percentage of the total possible score out of 100%. A threshold score of <50% is considered to be of limited potential use. RESULTS Twenty-three (79.31%) clinical practice guidelines were received from 29 invited facilities. The scaled results of the AGREE II domains were as follows: Scope and Purpose, mean = 73%, 95% confidence interval (CI) = 63-83%; Stakeholder Involvement, mean = 23%, 95% CI = 15-31%; Rigour of Development, mean = 17%, 95% CI = 12-21%; Clarity of Presentation, mean = 63%, 95% CI = 56-70%; Applicability, mean = 5%, 95% CI = 20-30%; and Editorial Independence, mean = 50%, 95% CI = 50-50%. Overall assessment indicated low methodological quality (31%; 22-39%), with only five clinical practice guidelines scoring >50%, suggesting that they could be recommended for use with modifications. The remaining 18 could not be recommended for use. CONCLUSIONS Neonatal ETT suction guidelines are of a low methodological quality. All guidelines poorly incorporated latest evidence in guideline development. This appraisal highlights the need to improve the quality of neonatal ETT suction guidelines to promote optimal patient care.
Collapse
Affiliation(s)
- Judith L Hough
- School of Allied Health, Australian Catholic University, Banyo, QLD 4104, Australia; Program for Optimising Outcomes for Mothers and Babies at Risk, Mater Research Institute - The University of Queensland, South Brisbane, QLD 4101, Australia.
| | - Jaimi Barton
- School of Allied Health, Australian Catholic University, Banyo, QLD 4104, Australia
| | - Luke A Jardine
- Department of Neonatology, Mater Mother's Hospital, South Brisbane, Qld 4101, Australia; The School of Medicine, The University of Queensland, St Lucia, Qld 4067, Australia
| |
Collapse
|
3
|
Ruszczyński M, Ambrożej D, Adamiec A, Ryczaj K, Elenius V, Cavkaytar O, Maggina P, Makrinioti H, Papadopoulos N, Hedlin G, Konradsen JR, Schaub B, H Smits H, Jartti T, Feleszko W. Preschool wheezing and asthma in children: A systematic review of guidelines and quality appraisal with the AGREE II instrument. Pediatr Allergy Immunol 2021; 32:92-105. [PMID: 32816386 DOI: 10.1111/pai.13334] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 06/26/2020] [Accepted: 08/02/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Asthma-like symptoms in preschool children, such as wheezing and dyspnea, are common time- and resource-consuming diagnostic and management challenges. Quality of wheezing and asthma recommendations varies. The purpose of this study, carried out by the European Academy of Allergy and Clinical Immunology (EAACI) Task Force for Preschool Wheeze, was to systematically review and assess the quality of guidelines for diagnosis and treatment of preschool wheezing and/or asthma. METHODS The Cochrane Library, MEDLINE, and EMBASE were searched until June 2018. The methodological rigor, quality, and transparency of relevant guidelines were assessed with the use of the Appraisal of Guidelines for Research and Evaluation (AGREE II) tool. RESULTS We identified 26 guidelines. The quality scores for each domain varied. Of all domains, clarity and presentation had the highest mean score, whereas applicability and stakeholder involvement had the lowest. The scores (median) for individual domains were as follows: score and purpose 86%; stakeholder involvement 49%; rigor of development 54%; clarity of presentation 85%; applicability 51%; and editorial independence 63%. CONCLUSION Although several guidelines on asthma management in children are available, however, their quality varies. Additionally, there is a considerable gap in reliable recommendations on the management and treatment of non-asthmatic preschool wheeze.
Collapse
Affiliation(s)
- Marek Ruszczyński
- Department of Pediatrics, Medical University of Warsaw, Warsaw, Poland
| | - Dominika Ambrożej
- Department of Pediatric Pneumonology and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Aleksander Adamiec
- Department of Pediatrics, Medical University of Warsaw, Warsaw, Poland.,Department of Pediatric Pneumonology and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Klaudia Ryczaj
- Department of Pediatric Pneumonology and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Varpu Elenius
- Department of Pediatrics, Turku University Hospital and University of Turku, Turku, Finland
| | - Ozlem Cavkaytar
- Department of Pediatric Allergy and Immunology, Goztepe Training and Research Hospital, Istanbul Medeniyet University Faculty of Medicine, Istanbul, Turkey
| | - Paraskevi Maggina
- Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece
| | | | - Nikolaos Papadopoulos
- Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece.,Division of Infection, Immunity & Respiratory Medicine, University of Manchester, Manchester, UK
| | - Gunilla Hedlin
- Astrid Lindgren Children's Hospital Karolinska University Hospital, Stockholm, Sweden.,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Jon R Konradsen
- Astrid Lindgren Children's Hospital Karolinska University Hospital, Stockholm, Sweden.,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Bianca Schaub
- Pediatric Allergology, Department of Pediatrics, German Center for Lung Research (DZL), Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany
| | - Hermelijn H Smits
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands
| | - Tuomas Jartti
- Department of Pediatrics, Turku University Hospital and University of Turku, Turku, Finland.,Department of Pediatrics, University of Oulu, Oulu, Finland
| | - Wojciech Feleszko
- Department of Pediatric Pneumonology and Allergy, Medical University of Warsaw, Warsaw, Poland
| | | |
Collapse
|