Kim Jin K, Chua Michael E, Ming Jessica M, Santos Joana Dos, Zani-Ruttenstock Elke, Marson Alanna, Bayley Mark, Koyle Martin A
Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada.
Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada.
J Pediatr Surg. 2018 Oct;53(10):2041-2047. doi: 10.1016/j.jpedsurg.2017.11.050. Epub 2017 Nov 24.
BACKGROUND/PURPOSE: Limited efforts have been made in assessing the qualities of clinical practice guidelines (CPGs) on cryptorchidism (UDT). This appraisal aims to determine the quality of recent CPGs on the management of UDT.
After systematic literature search, all English-based CPGs providing recommendations for the management of UDT from 2012 to 2017 were reviewed. Using the AGREE II (Appraisal of Guidelines and Research Evaluation) instrument, eligible CPGs were independently appraised by 5 reviewers. Domain scores were calculated and summarized. Intraclass coefficient (ICC) was used to assess for interrater reliability.
Five CPGs from Agency for Healthcare Research and Quality (AHRQ), American Urological Association (AUA), British Association of Pediatric Surgeons/British Association of Urologic Surgeons (BAPS/BAUS), Canadian Urological Association (CUA), and European Association of Urology/European Society for Pediatric Urology (EAU/ESPU) were assessed. There was a solid agreement (ICC: 0.749) among the 5 reviewers (p<0.001). Most recommendations for diagnostic and treatment approaches were consistent across CPGs. For most guidelines, the domains of 'clarity of presentation,' 'scope and purpose,' 'stakeholder involvement,' and 'rigor of development' were high, while 'applicability' was low.
Most guidelines on UDT score high in the AGREE II domains and have consistent recommendations. To improve the 'applicability' domain, future guidelines should improve on aspects that facilitate implementation of the recommendations.
Systematic review.
V (based on the lowest level of evidence utilized by the assessed guidelines).
背景/目的：在评估关于隐睾症（UDT）的临床实践指南（CPG）质量方面所做的工作有限。本评估旨在确定近期关于UDT管理的CPG的质量。
经过系统的文献检索，对2012年至2017年所有提供UDT管理建议的英文CPG进行了综述。使用AGREE II（指南评估与研究评价）工具，由5名评审员对符合条件的CPG进行独立评估。计算并汇总领域得分。使用组内相关系数（ICC）评估评分者间的可靠性。
对来自医疗保健研究与质量机构（AHRQ）、美国泌尿外科学会（AUA）、英国小儿外科医生协会/英国泌尿外科学会（BAPS/BAUS）、加拿大泌尿外科学会（CUA）以及欧洲泌尿外科学会/欧洲小儿泌尿外科学会（EAU/ESPU）的5份CPG进行了评估。5名评审员之间存在高度一致性（ICC：0.749）（p<0.001）。各CPG关于诊断和治疗方法的大多数建议是一致的。对于大多数指南而言，“表述清晰度”“范围和目的”“利益相关者参与”以及“制定的严谨性”等领域得分较高，而“适用性”得分较低。
大多数关于UDT的指南在AGREE II领域得分较高且建议一致。为提高“适用性”领域，未来的指南应在有助于建议实施的方面加以改进。
系统评价。
V（基于所评估指南使用的最低证据级别）。
