治疗新冠病毒病儿童的临床实践指南的质量与一致性
Quality and consistency of clinical practice guidelines for treating children with COVID-19.
作者信息
Li Qinyuan, Zhou Qi, Xun Yangqin, Liu Hui, Shi Qianling, Wang Zijun, Zhao Siya, Liu Xiao, Liu Enmei, Fu Zhou, Chen Yaolong, Luo Zhengxiu
机构信息
Department of Respiratory Medicine Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China.
The First School of Clinical Medicine, Lanzhou University, Lanzhou, China.
出版信息
Ann Transl Med. 2021 Apr;9(8):633. doi: 10.21037/atm-20-7000.
BACKGROUND
The Coronavirus Disease 2019 (COVID-19) pandemic negatively affects children's health. Many guidelines have been developed for treating children with COVID-19. The quality of the existing guidelines and the consistency of recommendations remains unknown. Therefore, we aim to review the clinical practice guidelines (CPGs) for children with COVID-19 systematically.
METHODS
We systematically searched Medline, Embase, guideline-related websites, and Google. The Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool and Reporting Items for practice Guidelines in HealThcare (RIGHT) checklist were used to evaluate the methodological and reporting quality of the included guidelines, respectively. The consistency of recommendations across the guidelines and their supporting evidence were analyzed.
RESULTS
Twenty guidelines were included in this study. The mean AGREE II score and mean RIGHT reporting rate of the included guidelines were 37% (range, 22-62%) and 52% (range, 31-89%), respectively. As for methodological quality, no guideline was classified as high, one guideline (5%) moderate, and 19 (95%) low. In terms of reporting quality, one guideline (5%) was rated as high, 12 guidelines (60%) moderate, and seven (35%) low. Among included guidelines, recommendations varied greatly in the use of remdesivir (recommend: 25%, not recommend: 45%, not report: 30%), interferon (recommend: 15%, not recommend: 50%, not report: 35%), glucocorticoids (recommend: 50%, not recommend: 20%, not report: 30%), and intravenous immune globulin (recommend: 35%, not recommend: 30%, not report: 35%). None of the guidelines cited clinical trials from children with COVID-19.
CONCLUSIONS
The methodological and reporting quality of guidelines for treating children with COVID-19 was not high. Recommendations were inconsistent across different guidelines. The supporting evidence from children with COVID-19 was very limited.
背景
2019年冠状病毒病（COVID-19）大流行对儿童健康产生了负面影响。已经制定了许多治疗COVID-19儿童的指南。现有指南的质量以及建议的一致性尚不清楚。因此，我们旨在系统地回顾COVID-19儿童的临床实践指南（CPG）。
方法
我们系统地检索了Medline、Embase、指南相关网站和谷歌。分别使用研究与评价指南II（AGREE II）工具和医疗保健实践指南报告条目（RIGHT）清单来评估纳入指南的方法学和报告质量。分析了各指南之间建议的一致性及其支持证据。
结果
本研究纳入了20项指南。纳入指南的平均AGREE II得分和平均RIGHT报告率分别为37%（范围：22%-62%）和52%（范围：31%-89%）。在方法学质量方面，没有指南被归类为高质量，1项指南（5%）为中等质量，19项（95%）为低质量。在报告质量方面，1项指南（5%）被评为高质量，12项指南（60%）为中等质量，7项（35%）为低质量。在纳入的指南中，关于瑞德西韦的使用建议差异很大（推荐：25%，不推荐：45%，未报告：30%），干扰素（推荐：15%，不推荐：50%，未报告：35%），糖皮质激素（推荐：50%，不推荐：20%，未报告：30%），以及静脉注射免疫球蛋白（推荐：35%，不推荐：30%，未报告：35%）。没有指南引用COVID-19儿童的临床试验。
结论
治疗COVID-19儿童的指南的方法学和报告质量不高。不同指南之间的建议不一致。来自COVID-19儿童的支持证据非常有限。
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