The quality of paediatric asthma guidelines: evidence underpinning diagnostic test recommendations from a meta-epidemiological study

Abstract

Background Asthma is one of the most frequent reasons children visit a general practitioner (GP). The diagnosis of childhood asthma is challenging, and a variety of diagnostic tests for asthma exist. GPs may refer to clinical practice guidelines when deciding which tests, if any, are appropriate, but the quality of these guidelines is unknown. Objectives To determine (i) the methodological quality and reporting of paediatric guidelines for the diagnosis of childhood asthma in primary care, and (ii) the strength of evidence supporting diagnostic test recommendations. Design Meta-epidemiological study of English-language guidelines from the United Kingdom and other high-income countries with comparable primary care systems including diagnostic testing recommendations for childhood asthma in primary care. The AGREE-II tool was used to assess the quality and reporting of the guidelines. The quality of the evidence was assessed using GRADE. Results Eleven guidelines met the eligibility criteria. The methodology and reporting quality varied across the AGREE II domains (median score 4.5 out of 7, range 2–6). The quality of evidence supporting diagnostic recommendations was generally of very low quality. All guidelines recommended the use of spirometry and reversibility testing for children aged ≥5 years, however, the recommended spirometry thresholds for diagnosis differed across guidelines. There were disagreements in testing recommendations for 3 of the 7 included tests. Conclusions The variable quality of guidelines, lack of good quality evidence, and inconsistent recommendations for diagnostic tests may contribute to poor clinician adherence to guidelines and variation in testing for diagnosing childhood asthma.

The quality of diagnostic guidelines for children in primary care: A meta‐epidemiological study

“…We previously performed a meta-epidemiological study of childhood asthma guidelines. 28 We found that the quality of evidence supporting diagnostic recommendations for asthma was poor, suggesting that guideline bodies need to advocate for better quality evidence to improve the delivery of diagnostic care for children.…”

Temporal trends and practice variation of paediatric diagnostic tests in primary care

“…Physical examination findings, anthropometric measurements, and vital signs were excluded. When analysing trends and variation in specific tests, we used a subset of tests restricted to (1) the 25 most frequently requested tests during the study period (2) tests that are frequently reported by primary care providers as requested for children or perceived to be subject to substantial variation in their use [18], or (3) from other literature that focused on paediatric diagnostic test use in primary care [12, 19, 20]. The resulting 35 included tests comprised approximately 80% of the total tests conducted (see Appendix Table 1 ).…”

A protocol for adapting a clinical practice guideline for the treatment of paediatric asthma for the Egyptian Pediatric Clinical Practice Guidelines Committee

“…9 There is a high variability in the quality of clinical practice guidelines (CPG) in general and of the paediatric asthma guidelines in particular globally and locally. [10][11][12] In 2019, the Scottish Intercollegiate Guidelines Network (SIGN) and the British Thoracic Society (BTS) updated the British guideline on the management of asthma (SIGN 158) including the recommendations for the best practice in the management of asthma in adults, including pregnant women and children. This CPG presented recommendations for asthma diagnosis, monitoring, supported self-management, nonpharmacological management, pharmacological management, inhaler devices, management of acute asthma, difficult asthma, asthma in adolescents, asthma in pregnancy, occupational asthma, organisation and delivery of care and provision of information.…”