Chua Michael, Ming Jessica, Chang Shang-Jen, Santos Joana Dos, Mistry Niraj, Silangcruz Jan Michael, Bayley Mark, Koyle Martin A
Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada.
St. Luke's Medical Centre, Quezon City, Philippines.
Can Urol Assoc J. 2018 Apr;12(4):112-118. doi: 10.5489/cuaj.4796. Epub 2017 Dec 22.
Concerns regarding the quality, credibility, and applicability of recently published pediatric urinary tract infection (UTI) clinical practice guidelines have been raised due to the inconsistencies of recommendations between them. We aimed to determine the quality of the recent clinical practice guidelines on pediatric UTI by using the Appraisal of Guidelines Research and Evaluation (AGREE II) instrument, and summarize the standard of care in diagnosis and management of pediatric UTI from the top three clinical practice guidelines.
A systematic literature search was performed on medical literature electronic databases and international guideline repository websites. English language-based clinical practice guidelines from 2007-2016 endorsed by any international society or government organization providing recommendations for the management of pediatric UTI were considered. Eligible clinical practice guidelines were independently appraised by six reviewers using the AGREE II tool. Clinical practice guidelines were assessed for standardized domains and summarized for overall quality. Inter-rater reliability was assessed using inter-class coefficient (ICC).
Thirteen clinical practice guidelines were critically reviewed. The Spanish clinical practice guidelines, American Academy of Pediatrics, and National Institute for Health and Clinical Excellence clinical practice guidelines consistently scored high on all AGREE domains (total averaged domain scores 90, 88, and 88, respectively). Among the six reviewers, there was a high degree of inter-rater reliability (average measure ICC 0.938; p<0.0001). There is reasonable consensus among the top three clinical practice guidelines in their major recommendations.
The clinical practice guidelines from Spain, American Academy of Pediatrics, and National Institute for Health and Clinical Excellence, with their major recommendations being similar, have scored highly on the AGREE II indicators of quality for the clinical practice guidelines development process.
由于近期发布的小儿尿路感染（UTI）临床实践指南之间的推荐意见不一致，人们对其质量、可信度和适用性提出了担忧。我们旨在使用指南研究与评价工具（AGREE II）来确定近期小儿UTI临床实践指南的质量，并总结三大临床实践指南中关于小儿UTI诊断和管理的护理标准。
在医学文献电子数据库和国际指南库网站上进行了系统的文献检索。纳入2007年至2016年期间由任何国际协会或政府组织认可的、基于英语的小儿UTI管理临床实践指南。符合条件的临床实践指南由六名评审员使用AGREE II工具独立评估。对临床实践指南的标准化领域进行评估，并总结其整体质量。使用组内相关系数（ICC）评估评分者间信度。
对13项临床实践指南进行了严格审查。西班牙临床实践指南、美国儿科学会和英国国家卫生与临床优化研究所的临床实践指南在所有AGREE领域的得分一直很高（平均总领域得分分别为90、88和88）。在六名评审员中，评分者间信度很高（平均测量ICC为0.938；p<0.0001）。三大临床实践指南在其主要推荐意见上有合理的共识。
西班牙、美国儿科学会和英国国家卫生与临床优化研究所的临床实践指南，其主要推荐意见相似，在AGREE II临床实践指南制定过程质量指标上得分很高。
