O'Donoghue K J M, Reed R D, Knight S R, O'Callaghan J M, Ayaz-Shah A A, Hassan S, Morris P J, Pengel L H M
Centre for Evidence in Transplantation, Clinical Effectiveness Unit Royal College of Surgeons of England London UK.
University of Alabama at Birmingham Comprehensive Transplant Institute Birmingham, Alabama USA.
BJS Open. 2017 Sep 14;1(4):97-105. doi: 10.1002/bjs5.17. eCollection 2017 Aug.
Clinical practice guidelines (CPGs) are widely used to inform the development of protocols for clinical management. Previous work has demonstrated that the quality of CPGs varies widely. This systematic review aimed to determine the quality of CPGs in kidney transplantation in the UK.
CPGs in kidney transplantation published between 2010 and 2017 were identified through searches of MEDLINE, NHS NICE Evidence, and websites of relevant UK societies. Using the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool, three appraisers rated the quality of CPGs across six domains, the overall quality of each CPG, and whether it should be recommended for future use. Domain scores were calculated, and inter-rater reliability using the intraclass correlation coefficient (ICC) was reported.
Thirteen CPGs met the inclusion criteria. The domain 'clarity of presentation' scored highest, followed closely by 'scope and purpose'. The poorest scoring domains were 'applicability' and 'editorial independence'. Editorial independence also had the widest range of scores. Of the 13 CPGs, one was not recommended for future use, seven were recommended for use with modifications, and five for future use with no need for modification. Mean overall CPG quality was 5 (range 3-6) of a maximum score of 7, and mean inter-rater reliability was substantial with an ICC of 0·71.
UK CPGs scored satisfactorily, although with wide variation in how well each domain scored both within and across CPGs. The quality of UK CPGs can still be improved.
临床实践指南（CPG）被广泛用于指导临床管理方案的制定。先前的研究表明，CPG的质量差异很大。本系统评价旨在确定英国肾脏移植领域CPG的质量。
通过检索MEDLINE、英国国家卫生与临床优化研究所（NHS NICE）证据库以及英国相关学会的网站，识别2010年至2017年间发表的肾脏移植CPG。使用研究与评价指南评估（AGREE）II工具，三名评估者对CPG在六个领域的质量、每个CPG的整体质量以及是否应推荐其未来使用进行评分。计算领域得分，并报告使用组内相关系数（ICC）的评估者间信度。
13份CPG符合纳入标准。“呈现清晰度”领域得分最高，紧随其后的是“范围和目的”。得分最低的领域是“适用性”和“编辑独立性”。编辑独立性的得分范围也最广。在这13份CPG中，一份不推荐未来使用，七份推荐经修改后使用，五份推荐无需修改即可用于未来。CPG的平均整体质量为7分制中的5分（范围为3 - 6分），评估者间信度较高，ICC为0.71。
英国CPG的得分令人满意，尽管每个领域在不同CPG之间以及同一CPG内部的得分差异很大。英国CPG的质量仍有提升空间。
