Department of Nursing, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China.
Department of Cardiac Surgery, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China.
BMJ Open. 2020 Dec 10;10(12):e040686. doi: 10.1136/bmjopen-2020-040686.
Venous thromboembolism (VTE) occurs in up to 40%-80% of patients after hip and knee arthroplasty. Clinical decision-making aided by guidelines is the most effective strategy to reduce the burden of VTE. However, the quality of guidelines is dependent on the strength of their evidence base. The objective of this article is to critically evaluate the quality of VTE prevention guidelines and the strength of their recommendations in VTE prophylaxis in patients undergoing hip and knee arthroplasty.
Relevant literature up to 16 March 2020 was systematically searched. We searched databases such as Web of Science, PubMed, EMBASE, Cumulative Index of Nursing and Allied Health Literature, China National Knowledge Infrastructure and WanFang and nine guidelines repositories. The identified guidelines were appraised by two reviewers using the Appraisal of Guidelines for Research and Evaluation II and appraised the strength of their recommendations independently. Following quality assessment, a predesigned data collection form was used to extract the characteristics of the included guideline.
We finally included 15 guidelines. Ten of the included guidelines were rated as 'recommended' or 'recommended with modifications'. The standardised scores were relatively high in the domains of Clarity of Presentation, and Scope and Purpose. The lowest average standardised scores were observed in the domains of Applicability and Stakeholder Involvement. In reference to the domains of Rigour of Development and Editorial Independence, the standardised scores varied greatly between the guidelines. The agreement between the two appraisers is almost perfect (intraclass correlation coefficients higher than 0.80). A considerable proportion of the recommendations is based on low-quality or very-low-quality evidence or is even based on working group expert opinion.
In summary, the majority of the recommendations are based on low-quality evidence, and further confirmation is needed. Furthermore, guideline developers should pay more attention to methodological quality, especially in the Stakeholder Involvement domain and the Applicability domain.
髋关节和膝关节置换术后，多达 40%-80%的患者会发生静脉血栓栓塞症（VTE）。借助指南进行临床决策是降低 VTE 负担的最有效策略。然而，指南的质量取决于其证据基础的强度。本文的目的是批判性地评估 VTE 预防指南的质量以及其在髋关节和膝关节置换术后 VTE 预防中的推荐建议的强度。
系统检索截至 2020 年 3 月 16 日的相关文献。我们检索了 Web of Science、PubMed、EMBASE、护理学及相关健康领域累积索引、中国知网和万方以及九个指南库等数据库。两名评审员使用评估研究和评估 II 指南的方法对确定的指南进行评估，并独立评估其推荐建议的强度。在质量评估后，使用预先设计的数据采集表提取纳入指南的特征。
我们最终纳入了 15 项指南。其中 10 项指南被评为“推荐”或“推荐修改”。在陈述清晰、范围和目的方面，标准化得分相对较高。在适用性和利益相关者参与方面，平均标准化得分最低。在发展严谨性和编辑独立性方面，指南之间的标准化得分差异很大。两位评审员之间的一致性几乎是完美的（组内相关系数高于 0.80）。相当一部分建议是基于低质量或极低质量的证据，甚至是基于工作组专家意见。
综上所述，大多数建议都是基于低质量的证据，需要进一步确认。此外，指南制定者应更加关注方法学质量，特别是在利益相关者参与和适用性方面。
