Department of Thoracic Surgery, AUSL Romagna Teaching Hospital, Ravenna, Italy.
Thoracic Surgery Unit, University College London Hospital, London, UK.
Eur J Cardiothorac Surg. 2017 Aug 1;52(2):356-362. doi: 10.1093/ejcts/ezx089.
In the European Society of Thoracic Surgeons (ESTS) survey about management of malignant pleural effusions (MPE), 56% of respondents are not informed of any relevant clinical guidelines and 52%, who are aware of the existence of guidelines, declared that they are in need of updating or revision. The ESTS Pleural Diseases Working Group developed a benchmarking project on quality of previous guidelines on the management of MPE.
The Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument was used to assess each guideline. Each item was scored on a 7-point scale. Scores for each domain were calculated. Economic data for the nations which have issued the guidelines were collected from the Organisation for Economic Cooperation and Development health statistics database.
Six guidelines fitted the inclusion criteria and were assessed. Five out of 6 guidelines were produced by a multinational collaboration. Observers would recommend only 2 guidelines with minimal modification. Two areas that received the best score were clarity of presentation and scope and purpose (objectives and health questions target population). The applicability of guideline domain had the lowest score. Multivariate analysis demonstrated that clarity of presentation, international guidelines and publication through medical journal were related to improved scores. A strong correlation was observed between the measures of economic status.
The quality of guidelines assessed by the AGREE II criteria was found to be extremely variable. Guidelines achieving higher AGREE II scores were more likely to come from the European Union with the direct involvement of scientific societies in their development. It was also recognized that some fundamental unanswered questions remain about the management of MPE.
在欧洲胸外科协会（ESTS）关于恶性胸腔积液（MPE）管理的调查中，56%的受访者未被告知任何相关临床指南，而 52%知晓指南存在的受访者则表示指南需要更新或修订。ESTS 胸膜疾病工作组针对 MPE 管理指南的质量制定了基准项目。
采用评估指南研究和评估（AGREE II）工具对每条指南进行评估。每个项目的评分范围为 1 到 7 分。每个领域的分数均进行了计算。从经济合作与发展组织卫生统计数据库中收集了发布指南的国家的经济数据。
符合纳入标准并进行评估的指南有 6 条。其中 5 条指南由多国合作产生。观察者建议仅对 2 条指南进行最小修改后推荐使用。获得最高分的两个领域是表述的清晰度以及范围和目的（目标和卫生问题的目标人群）。指南领域的适用性得分最低。多变量分析表明，表述的清晰度、国际指南以及通过医学期刊发布与评分提高有关。经济状况的衡量指标之间存在很强的相关性。
通过 AGREE II 标准评估的指南质量差异极大。AGREE II 得分较高的指南更有可能来自欧盟，并且其制定过程中有科学协会的直接参与。此外，人们认识到，MPE 管理仍存在一些基本的未解决问题。
