Department of Pediatrics University of Naples Federico II, Naples, Italy.
J Pediatr Gastroenterol Nutr. 2011 Feb;52(2):183-9. doi: 10.1097/MPG.0b013e3181e233ac.
The aim of the study was to assess the quality of clinical practice guidelines (CPGs) using the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument, a validated international tool.
CPGs were identified by searching MEDLINE (1966-January 2009) and Embase (1988-January 2009), CPG databases, and relevant Web sites of agencies and organizations that produce and/or endorse guidelines. Included in the study were CPGs in English that addressed the management of acute gastroenteritis in children. Retrieved CPGs were evaluated with the AGREE instrument for quality assessment by 6 independent reviewers. AGREE consists of 6 domains for a total of 23 items.
Nine CPGs were identified. Four were evidence based (EB) and 2 of these included tables of evidence. Eight CPGs (88%) scored <50% for "applicability," 7 (77%) for "stakeholder involvement," and 6 (66%) for "editorial independence." Compared with non-EB CPGs, EB CPGs had higher quality scores for all AGREE domains, with a better score for "rigor of development" (P < 0.001), "stakeholder involvement" and "clarity of presentation" (P < 0.01), and applicability (P < 0.05). Over time, the quality of guidelines tended to improve. The main recommendations of CPGs were similar. However, there were differences in the treatment of diarrhea, namely based on the settings and circumstances in which CPGs were produced.
The overall quality of CPGs on acute gastroenteritis management in children is fair. Aims, target population, synthesis of evidence, formulation of recommendations, and clarity of presentation are points of strength. Weak issues are applicability, including identification of organizational barriers and adherence parameters, and cost/efficacy analysis.
本研究旨在使用经过验证的国际工具——评估指南研究和评估工具（AGREE）来评估临床实践指南（CPG）的质量。
通过检索 MEDLINE（1966 年 1 月至 2009 年 1 月）和 Embase（1988 年 1 月至 2009 年 1 月）、CPG 数据库以及制作和/或认可指南的机构和组织的相关网站，确定 CPG。本研究纳入的 CPG 为英文，内容涉及儿童急性胃肠炎的管理。由 6 名独立评审员使用 AGREE 工具评估所获取的 CPG 以进行质量评估。AGREE 由 6 个领域组成，共计 23 个项目。
确定了 9 项 CPG。其中 4 项为循证（EB）CPG，其中 2 项包含证据表格。8 项 CPG（88%）在“适用性”方面的得分<50%，7 项（77%）在“利益相关者参与”方面，6 项（66%）在“编辑独立性”方面。与非 EB CPG 相比，EB CPG 在所有 AGREE 领域的质量评分均较高，在“制定的严谨性”（P <0.001）、“利益相关者参与”和“表述的清晰度”（P <0.01）以及适用性（P <0.05）方面得分更高。随着时间的推移，指南的质量趋于提高。CPG 的主要建议相似。但是，在腹泻的治疗方面，存在差异，这主要基于 CPG 制定的背景和环境。
儿童急性胃肠炎管理 CPG 的总体质量尚可。目的、目标人群、证据综合、建议制定和表述的清晰度是优势所在。薄弱环节包括适用性，包括确定组织障碍和依从性参数以及成本/效果分析。
