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 e… Show more
“…Our findings are limited to guidelines relevant to a primary care setting to better understand how GPs diagnose children, and we only focused on three of the most common conditions affecting children. Other reviews have sought to look at the issue more broadly across a wide range of conditions 9,10 . Their findings are consistent with this review's findings suggesting that guidance for paediatric conditions in primary care is generally of poor quality.…”
Section: Discussionsupporting
confidence: 70%
“…One study assessed the quality and reporting of diagnostic testing guidelines for adults presenting to primary care; however, no similar study exists in children 8 . A systematic review determined that the quality of 159 paediatric guidelines from 1990 to 2020 improved over time but remained sub‐optimal 9 . Another review examining the quality of 216 paediatric guidelines published from 2017 to 2019 found that quality was influenced by whether the guidelines were under the responsibility of organisations or groups, if evidence‐based methods were used to develop guidelines, and the socio‐economic development index of a country (i.e.…”
Section: What Is Already Known On This Topicmentioning
confidence: 99%
“…8 A systematic review determined that the quality of 159 paediatric guidelines from 1990 to 2020 improved over time but remained sub-optimal. 9 Another review examining the quality of 216 paediatric guidelines published from 2017 to 2019 found that quality was influenced by whether the guidelines were under the responsibility of organisations or groups, if evidence-based methods were used to develop guidelines, and the socio-economic development index of a country (i.e. countries from less economically developed countries had lower quality scores in four of the six quality domains).…”
AimTo determine the quality of paediatric guidelines relevant to diagnosis of three of the most common conditions in primary care: fever, gastroenteritis and constipation.MethodsWe undertook a meta‐epidemiological study of paediatric guidelines for fever, gastroenteritis and gastroenteritis. We systematically searched MEDLINE, Embase, Trip Database, Guidelines International Network, the National Guideline Clearinghouse and WHO from February 2011 to September 2022 for guidelines from high‐income settings containing diagnostic recommendations. We assessed the quality of guideline reporting for included guidelines using the AGREE II tool.ResultsWe included 16 guidelines: fever (n = 7); constipation (n = 4) and gastroenteritis (n = 5). The overall quality across the three conditions was graded moderate (median AGREE II score 4.5/7, range 2.5–6.5) with constipation guidelines rated the highest (median 6/7), and fever rated the lowest (median 3.8/7). Major methodological weaknesses included consideration of guideline applicability. Half of the guidelines did not report involving parent representatives, and 56% did not adequately declare or address their competing interests.ConclusionsSubstantial variations exist in the quality of paediatric guidelines related to the diagnosis of primary care presentations. Better quality guidance is needed for general practitioners to improve diagnosis for children in primary care.
“…Our findings are limited to guidelines relevant to a primary care setting to better understand how GPs diagnose children, and we only focused on three of the most common conditions affecting children. Other reviews have sought to look at the issue more broadly across a wide range of conditions 9,10 . Their findings are consistent with this review's findings suggesting that guidance for paediatric conditions in primary care is generally of poor quality.…”
Section: Discussionsupporting
confidence: 70%
“…One study assessed the quality and reporting of diagnostic testing guidelines for adults presenting to primary care; however, no similar study exists in children 8 . A systematic review determined that the quality of 159 paediatric guidelines from 1990 to 2020 improved over time but remained sub‐optimal 9 . Another review examining the quality of 216 paediatric guidelines published from 2017 to 2019 found that quality was influenced by whether the guidelines were under the responsibility of organisations or groups, if evidence‐based methods were used to develop guidelines, and the socio‐economic development index of a country (i.e.…”
Section: What Is Already Known On This Topicmentioning
confidence: 99%
“…8 A systematic review determined that the quality of 159 paediatric guidelines from 1990 to 2020 improved over time but remained sub-optimal. 9 Another review examining the quality of 216 paediatric guidelines published from 2017 to 2019 found that quality was influenced by whether the guidelines were under the responsibility of organisations or groups, if evidence-based methods were used to develop guidelines, and the socio-economic development index of a country (i.e. countries from less economically developed countries had lower quality scores in four of the six quality domains).…”
AimTo determine the quality of paediatric guidelines relevant to diagnosis of three of the most common conditions in primary care: fever, gastroenteritis and constipation.MethodsWe undertook a meta‐epidemiological study of paediatric guidelines for fever, gastroenteritis and gastroenteritis. We systematically searched MEDLINE, Embase, Trip Database, Guidelines International Network, the National Guideline Clearinghouse and WHO from February 2011 to September 2022 for guidelines from high‐income settings containing diagnostic recommendations. We assessed the quality of guideline reporting for included guidelines using the AGREE II tool.ResultsWe included 16 guidelines: fever (n = 7); constipation (n = 4) and gastroenteritis (n = 5). The overall quality across the three conditions was graded moderate (median AGREE II score 4.5/7, range 2.5–6.5) with constipation guidelines rated the highest (median 6/7), and fever rated the lowest (median 3.8/7). Major methodological weaknesses included consideration of guideline applicability. Half of the guidelines did not report involving parent representatives, and 56% did not adequately declare or address their competing interests.ConclusionsSubstantial variations exist in the quality of paediatric guidelines related to the diagnosis of primary care presentations. Better quality guidance is needed for general practitioners to improve diagnosis for children in primary care.
“…The guideline ecosystem has shifted from a consensus‐based approach, to a structured, transparent and evidence‐informed development of recommendations for clinical practice and health policy. 1 , 2 , 3 , 4 , 5 , 6 Major organizations and initiatives, such as the Grading of Recommendations Assessment, Development and Evaluation (GRADE), the Guidelines International Network (GIN), the Scottish Intercollegiate Guidelines Network (SIGN), the National Institute for Health and Care Excellence (NICE), and the World Health Organization (WHO), among other, have fostered a culture of evidence‐informed methodology in guideline development. 7 , 8 , 9 , 10 , 11 , 12 Key summary AGREE II was developed to inform the methodology of clinical practice guidelines.…”
Background: The Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument has been developed to inform the methodology, reporting and appraisal of clinical practice guidelines. Evidence suggests that the quality of surgical guidelines can be improved, and the structure and content of AGREE II can be modified to help enhance the quality of guidelines of surgical interventions. Objective: To develop an extension of AGREE II specifically designed for guidelines of surgical interventions.
Methods:In the tripartite Guideline Assessment Project (GAP) funded by United European Gastroenterology and the European Association for Endoscopic Surgery, (i) we assessed the quality of surgical guidelines and we identified factors associated with higher quality (GAP I); (ii) we applied correlation analysis, factor analysis andThis is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
“…Transparent and rigorous recommendations in the CPGs can not only help clinicians make appropriate decisions e ciently, but also ensure medical safety [3,4]. However, with the rapid development of evidence-based medicine, although the number of Chinese CPGs is growing rapidly, the rigor of formulating recommendations is lower than the international level [5][6][7].…”
Background: The general situation of the methodological quality of the process of moving from evidence to recommendations (EtR) in Chinese CPGs and the main methodological factors affecting the rigor of EtR is still unclear. This study explored the status of the methodological characteristics of EtR by analyzing of all Chinese CPGs illustrating recognizable recommendations published during the period 2010-2020, and identified the relevant factors associated with the rigor of EtR in CPGs.Methods: We systematically searched two major Chinese databases, CNKI and WanFang Database to gather all CPGs illustrating recognizable recommendations from 2010 to 2020. A data-extraction form was designed to extract all the methodological characteristics of EtR. We used the M-K test to identify monotonically increasing or decreasing trends of each methodological characteristic over time, and compared the methodological characteristics between groups using Chi-square test. Multi-factor Binary Logistic regression analysis was used to analyze factors related to the rigor of the process of EtR in CPGs.Results: A total of 753 CPGs (EB-CPGs=386/1,127, CB-CPGs=367/1,527) were selected based on the selection criteria. EB-CPGs did better than CB-CPGs in most of the EtR methodological characteristics, and CPGs using GRADE were also superior to those not using GRADE. 43.69% (329/753) of CPGs considered relevant factors. The most frequently considered factors were the effectiveness of the intervention (398, 52.9%), safety (368, 48.9%), and balance of benefits and harms (193, 25.6%). Only 95 CPGs considered costs in the methods or the process of EtR, the proportion was even lower for the consideration of values and preferences (57, 7.6%) and feasibility (47, 6.2%). The rigor of EtR were significantly associated with GRADE or non-GRADE CPGs (OR 2.03, 95% CI 1.37-3.00, P< 0.001), EB-CPGs or CB-CPGs (OR 1.48, 95%CI 1.06-2.07, P=0.022) and the designated level of evidence (OR 1.64, 95% CI 1.15-2.34, P=0.006).Conclusion: Unsatisfactory: there is still much room for improvement in the rigor of EtR in Chinese CPGs over the last 11 years. In order to improve the rigor of EtR, guideline panels should try to consider all the relevant factors. Additionally, EB-CPGs using GRADE are preferable for enhancing the EtR rigor.
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