Bakel Leigh Anne, Hamid Jemila, Ewusie Joycelyne, Liu Kai, Mussa Joseph, Straus Sharon, Parkin Patricia, Cohen Eyal
Section of Pediatric Hospital Medicine and the Clinical Effectiveness Team, Department of Pediatrics, Children's Hospital Colorado, Aurora, Colorado;
Li Ka Shing Knowledge Institute, St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada.
Pediatrics. 2017 Nov;140(5). doi: 10.1542/peds.2017-0092.
Guideline recommendations for the same clinical condition may vary. The purpose of this study was to determine the degree of agreement among comparable asthma and bronchiolitis treatment recommendations from guidelines.
National and international guidelines were searched by using guideline databases (eg, National Guidelines Clearinghouse: December 16-17, 2014, and January 9, 2015). Guideline recommendations were categorized as (1) recommend, (2) optionally recommend, (3) abstain from recommending, (4) recommend against a treatment, and (5) not addressed by the guideline. The degree of agreement between recommendations was evaluated by using an unweighted and weighted κ score. Pairwise comparisons of the guidelines were evaluated similarly.
There were 7 guidelines for asthma and 4 guidelines for bronchiolitis. For asthma, there were 166 recommendation topics, with 69 recommendation topics given in ≥2 guidelines. For bronchiolitis, there were 46 recommendation topics, with 21 recommendation topics provided in ≥2 guidelines. The overall κ for asthma was 0.03, both unweighted (95% confidence interval [CI]: -0.01 to 0.07) and weighted (95% CI: -0.01 to 0.10); for bronchiolitis, it was 0.32 unweighted (95% CI: 0.16 to 0.52) and 0.15 weighted (95% CI: -0.01 to 0.5).
Less agreement was found in national and international guidelines for asthma than for bronchiolitis. Additional studies are needed to determine if differences are based on patient preferences and values and economic considerations or if other recommendation-level, guideline-level, and condition-level factors are driving these differences.
针对同一临床状况的指南建议可能存在差异。本研究的目的是确定不同指南中关于哮喘和细支气管炎的可比治疗建议之间的一致程度。
通过使用指南数据库（如国家指南资料库：2014年12月16 - 17日以及2015年1月9日）检索国内和国际指南。指南建议被分类为：（1）推荐；（2）可选择推荐；（3）不做推荐；（4）反对某种治疗；（5）指南未涉及。使用未加权和加权κ评分评估建议之间的一致程度。对指南进行两两比较时也采用类似方法评估。
有7项哮喘指南和4项细支气管炎指南。对于哮喘，有166个推荐主题，其中69个推荐主题在≥2项指南中提及。对于细支气管炎，有46个推荐主题，其中21个推荐主题在≥2项指南中提及。哮喘的总体未加权κ值为0.03（95%置信区间[CI]：-0.01至0.07），加权κ值为0.03（95%CI：-0.01至0.10）；对于细支气管炎，未加权κ值为0.32（95%CI：0.16至0.52），加权κ值为0.15（95%CI：-0.01至0.5）。
在国内和国际指南中，哮喘方面的一致性低于细支气管炎。需要进一步研究以确定这些差异是基于患者偏好、价值观和经济因素，还是其他推荐级别、指南级别和疾病级别的因素导致的。
