Quality assessment of clinical practice guidelines for the management of paediatric dental emergencies applicable to the COVID-19 pandemic, using the AGREE II instrument. A systematic review

Abstract

Objective To assess the quality of Clinical Practice Guidelines (CPG) related to the management of paediatric dental emergencies applicable to the COVID-19 pandemic, through the use of the measuring instrument AGREE II (Appraisal of Guidelines for Research and Evaluation in Europe). Sources and Data collection A rigurous online search of CPG was accomplished among the main CPG compilers: National Institute for Health and Care Excellence (NICE), National Guideline Clearinghouse, Agency for Healthcare, Research and Quality (AHRQ), Andalusian Health Technology Assessment Department (AETSA), American Academy of Family Physicians, Tripdatabase. Furthermore, because of the need to identify CPG that meet the inclusion criteria, a manual search, among the main national and international dental organizations as well as recognized web sites, was also accomplished. Selection of research studies All of the guides focused on paediatric dental emergencies, available in the database and “gray” literature, and published between 2000 and 2020 (applicable to COVID-19 pandemic) were included without any language restrictions. The CPG that did not contain the full paper or were addressed to adults or children with special needs, were excluded from the selection. The evaluation of the CPG, independently included, were achieved by four (04) experts by using AGREE II. Results Five (05) out of twenty-three (23) selected CPG, were classified as “acceptable” according to AGREE II. These five guides were evaluated to determine their “Recommendation degree”. Only one (01) CPG “Guía Clínica AUGE de Urgencias Odontológicas Ambulatorias-Chile, 2011” reached a score of 75%, the highest among the other guides (5 domains with a score >= 60%, including the domain III “Rigour of Development”) to be considered as a “highly recommended” CPG. Conclusions According to the quality assessment and recommendation degrees criteria from AGREE II, high, middle and low quality CPG were identified. Only one CPG reached a score of 75%, to be classified as “highly recommended”. Therefore, it is suggested that the existing CPG updates and future CPG use the available tools and methodologies during their elaboration, in order to guarantee their quality. Clinical significance High quality CPG for the management of dental emergencies are designed to support dental health professionals in decision-making to adopt specific dental procedures in the current COVID-19 pandemic. As a matter of fact, these CPG might contribute to reduce the risk of transmission, in case of fresh outbreak of the illness. Likewise, they might help to determine which cases warrant medical attention in centres with special facilities for COVID-19.

Quality Appraisal of Clinical Practice Guidelines on Provision of Dental Services During the First Months of the Covid-19 Pandemic

“…The low score for the remaining domains, was also reported for other guidelines carried out in the context of the COVID-19 pandemic. 46 , 47 Norris et al 48 who evaluated WHO guidelines generated during four previous emergencies related to recent infectious diseases (H1N1, H7N9 virus, MERS-CoV, and Ebola), concluded that few guidelines met international standards for reliable and evidence-based CPGs. Moreover, they pointed out CPGs´ weaknesses, such as limited mention of systematic reviews, failure to perform external peer reviews, and incomplete information with regard to development methods.…”

“…In our research, only two guidelines 27 , 28 presented a score higher than 60% in at least three domains. Notwithstanding the above, whether performed during or outside a pandemic context, 46 , 47 , 49 the quality of the CPGs in the dental field in general tend to be of substandard quality with AGREE II overall rate.…”

“…This is also consistent with guidelines developed in response to health emergencies for both disease outbreaks, 48 , 50 and guidelines developed in times of the COVID-19 pandemic. 46 , 47 , 52 …”

Guías de práctica clínica para el tratamiento de la enfermedad por Covid-19 en Brasil: revisión sistemática

“…É importante que o desenvolvimento de diretriz siga um rigor na metodologia para que seja aplicada em diversos serviços, especialmente na área da saúde, com a declaração de quaisquer tipos de influência e/ou conflitos entre as organizações financiadoras e o conteúdo do documento 39 . Ressalta-se que raramente as instituições financeiras fazem declaração explícita de que seus interesses não influenciaram as recomendações, entretanto, são cruciais para uma boa avaliação [40][41] .…”

“…A baixa pontuação do domínio D5 se deve à falta de descrição das potencialidades, riscos, benefícios e estratégias na implementação das recomendações, as quais, na maioria, se referem ao uso farmacológico no tratamento da Covid-19, em que ainda persistem dúvidas e que necessitam de maior investigação 40 .…”