Hester Gabrielle, Nelson Katherine, Mahant Sanjay, Eresuma Emily, Keren Ron, Srivastava Rajendu
Department of Pediatrics, University of Utah, Salt Lake City, Utah.
J Hosp Med. 2014 Jun;9(6):384-90. doi: 10.1002/jhm.2187. Epub 2014 Mar 28.
Guidelines help inform standardization of care for quality improvement (QI). The Pediatric Research in Inpatient Settings network published a prioritization list of inpatient conditions with high prevalence, cost, and variation in resource utilization across children's hospitals. The methodological quality of guidelines for priority conditions is unknown.
To rate the methodological quality of national guidelines for 20 priority pediatric inpatient conditions.
We searched sources including PubMed for national guidelines published from 2002 to 2012. Guidelines specific to 1 organism, test or treatment, or institution were excluded. Guidelines were rated by 2 raters using a validated tool (Appraisal of Guidelines for Research and Evaluation) with an overall rating on a 7-point scale (7 = the highest). Inter-rater reliability was measured with a weighted kappa coefficient.
Seventeen guidelines met inclusion criteria for 13 conditions; 7 conditions yielded no relevant national guidelines. The highest methodological-quality guidelines were for asthma, tonsillectomy, and bronchiolitis (mean overall rating 7, 6.5, and 6.5, respectively); the lowest were for sickle cell disease (2 guidelines) and dental caries (mean overall rating 4, 3.5, and 3, respectively). The overall weighted kappa was 0.83 (95% confidence interval 0.78-0.87).
We identified a group of moderate to high methodological-quality national guidelines for priority pediatric inpatient conditions. Hospitals should consider these guidelines to inform QI initiatives.
指南有助于为质量改进（QI）的护理标准化提供信息。住院儿童研究网络发布了一份住院疾病优先级列表，这些疾病在儿童医院中具有高患病率、高成本且资源利用存在差异。优先级疾病指南的方法学质量尚不清楚。
对20种优先儿科住院疾病的国家指南的方法学质量进行评分。
我们检索了包括PubMed在内的来源，以查找2002年至2012年发布的国家指南。排除特定于1种生物体、测试或治疗或机构的指南。由2名评分者使用经过验证的工具（研究与评估指南评估）对指南进行评分，总体评分采用7分制（7分 = 最高）。使用加权kappa系数测量评分者间的可靠性。
17项指南符合13种疾病的纳入标准；7种疾病未产生相关的国家指南。方法学质量最高的指南是关于哮喘、扁桃体切除术和细支气管炎（总体平均评分分别为7分、6.5分和6.5分）；最低的是镰状细胞病（2项指南）和龋齿（总体平均评分分别为4分、3.5分和3分）。总体加权kappa为0.83（95%置信区间0.78 - 0.87）。
我们确定了一组针对优先儿科住院疾病的方法学质量中等至高的国家指南。医院应考虑这些指南以指导质量改进举措。
