Epidemic Research Group, University of Oxford, Oxford OX3 7LG, UK
Epidemic Research Group, University of Oxford, Oxford OX3 7LG, UK.
BMJ. 2020 May 26;369:m1936. doi: 10.1136/bmj.m1936.
To appraise the availability, quality, and inclusivity of clinical guidelines produced in the early stage of the coronavirus disease 2019 (covid-19) pandemic.
Rapid review.
Ovid Medline, Ovid Embase, Ovid Global Health, Scopus, Web of Science Core Collection, and WHO Global Index Medicus, searched from inception to 14 Mar 2020. Search strategies applied the CADTH database guidelines search filter, with no limits applied to search results. Further studies were identified through searches of grey literature using the ISARIC network.
Clinical guidelines for the management of covid-19, Middle East respiratory syndrome (MERS), and severe acute respiratory syndrome (SARS) produced by international and national scientific organisations and government and non-governmental organisations relating to global health were included, with no exclusions for language. Regional/hospital guidelines were excluded. Only the earliest version of any guideline was included.
Quality was assessed using the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool. The quality and contents of early covid-19 guidelines were also compared with recent clinical guidelines for MERS and SARS.
2836 studies were identified, of which 2794 were excluded after screening. Forty two guidelines were considered eligible for inclusion, with 18 being specific to covid-19. Overall, the clinical guidelines lacked detail and covered a narrow range of topics. Recommendations varied in relation to, for example, the use of antiviral drugs. The overall quality was poor, particularly in the domains of stakeholder involvement, applicability, and editorial independence. Links between evidence and recommendations were limited. Minimal provision was made for vulnerable groups such as pregnant women, children, and older people.
Guidelines available early in the covid-19 pandemic had methodological weaknesses and neglected vulnerable groups such as older people. A framework for development of clinical guidelines during public health emergencies is needed to ensure rigorous methods and the inclusion of vulnerable populations.
PROSPERO CRD42020167361.
评价 2019 年冠状病毒病(COVID-19)大流行早期制定的临床指南的可用性、质量和包容性。
快速审查。
Ovid Medline、Ovid Embase、Ovid 全球健康、Scopus、Web of Science 核心合集和世界卫生组织全球医学索引,从创建到 2020 年 3 月 14 日进行搜索。搜索策略应用了 CADTH 数据库指南搜索筛选器,对搜索结果没有任何限制。通过 ISARIC 网络搜索灰色文献进一步确定了其他研究。
纳入了国际和国家科学组织以及与全球健康相关的政府和非政府组织制定的 COVID-19、中东呼吸综合征(MERS)和严重急性呼吸综合征(SARS)管理临床指南,语言不限,排除区域/医院指南。仅纳入任何指南的最早版本。
使用评估指南研究和评价(AGREE)II 工具评估质量。还比较了 COVID-19 早期指南的质量和内容与最近的 MERS 和 SARS 临床指南。
共确定了 2836 项研究,筛选后排除了 2794 项。考虑纳入 42 条指南,其中 18 条专门针对 COVID-19。总体而言,临床指南缺乏细节,涵盖的主题范围较窄。建议在抗病毒药物的使用等方面有所不同。总体质量较差,特别是在利益相关者参与、适用性和编辑独立性方面。证据与建议之间的联系有限。很少为孕妇、儿童和老年人等弱势群体提供服务。
COVID-19 大流行早期的指南存在方法学上的弱点,忽视了老年人等弱势群体。需要制定公共卫生紧急情况下制定临床指南的框架,以确保严格的方法和纳入弱势群体。
PROSPERO CRD42020167361。