儿科临床实践指南的方法学与报告质量：一项系统综述

Methodological and reporting quality of pediatric clinical practice guidelines: a systematic review.

作者信息

Zhang Shu, Wu Lei, Wang Yang, Zhou Qi, Luo Xufei, Mathew Joseph L, Wang Qi, Song Yang, Chen Yaolong

机构信息

Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory, 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 Aug;9(15):1258. doi: 10.21037/atm-21-2686.

DOI:10.21037/atm-21-2686

PMID:34532395

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8421971/

Abstract

BACKGROUND

Pediatric clinical practice guidelines (CPGs) can provide systematically developed clinical recommendations to guide pediatric clinicians and patients making decisions. This study aims to assess the methodological and reporting quality of pediatric CPGs.

METHODS

We performed a systematic literature search of MEDLINE from 1 January 1990 to 2 April 2020 to identify pediatric CPGs published in the ten highest-impact pediatric journals and four highest-impact general medical journals. Two researchers evaluated the methodological and reporting quality of pediatric CPGs using the Appraisal of Guidelines Research and Evaluation (AGREE) II instrument and Reporting Items for Practice Guidelines in Health care (RIGHT) checklist. We calculated the mean AGREE II scores and compliance to RIGHT overall, and for each domain of the respective tools. We compared the methodological and reporting quality by different time periods and calculated the correlation between the AGREE II score and compliance to RIGHT.

RESULTS

A total of 159 pediatric CPGs were identified. The mean (± standard deviation) scores for the six domains of the AGREE II instrument were as follows: scope and purpose 74.5%±14.2%, stakeholder involvement 42.7%±16.2%, rigour of development 18.7%±14.2%, clarity of presentation 56.5%±17.0%, applicability 8.9%±12.7% and editorial independence 25.2%±34.6%. The overall assessment score was 37.8%±12.4%. The mean compliance to RIGHT items in the seven domains of the checklist were: basic information 73.6%±14.9%, background 67.1%±16.4%, evidence 32.7%±27.2%, recommendations 32.4%±22.5%, review and quality assurance 22.9%±40.4%, funding and declaration and management of interests 24.1%±36.3%, and other information 45.3%±30.1%. The overall reporting rate for RIGHT was 46.4%±16.6%. Both the AGREE II scores and RIGHT reporting rates increased over time. We found a high positive correlation between AGREE II scores and RIGHT reporting compliance (r=0.645, P<0.001).

DISCUSSION

The methodological and reporting quality of pediatric CPGs have improved over time, but remain still suboptimal and needs to be further improved. An international database of pediatric guidelines is urgently needed to identify and promote high-quality guidelines and guide clinical practice in pediatrics.

摘要

背景

儿科临床实践指南（CPGs）可以提供系统制定的临床建议，以指导儿科临床医生和患者做出决策。本研究旨在评估儿科CPGs的方法学和报告质量。

方法

我们对1990年1月1日至2020年4月2日期间的MEDLINE进行了系统的文献检索，以确定在十本影响最大的儿科期刊和四本影响最大的综合医学期刊上发表的儿科CPGs。两名研究人员使用指南研究与评价（AGREE）II工具和医疗保健实践指南报告条目（RIGHT）清单评估儿科CPGs的方法学和报告质量。我们计算了AGREE II的平均得分以及总体上和各工具每个领域对RIGHT的依从性。我们比较了不同时间段的方法学和报告质量，并计算了AGREE II得分与对RIGHT依从性之间的相关性。

结果

共识别出159篇儿科CPGs。AGREE II工具六个领域的平均（±标准差）得分如下：范围和目的74.5%±14.2%，利益相关者参与42.7%±16.2%，制定的严谨性18.7%±14.2%，呈现的清晰度56.5%±17.0%，适用性8.9%±12.7%，编辑独立性25.2%±34.6%。总体评估得分为37.8%±12.4%。清单七个领域中对RIGHT条目的平均依从性为：基本信息73.6%±14.9%，背景67.1%±16.4%，证据32.7%±27.2%，推荐32.4%±22.5%，审核与质量保证22.9%±40.4%，资金、利益声明与管理24.1%±36.3%，以及其他信息45.3%±30.1%。RIGHT的总体报告率为46.4%±16.6%。AGREE II得分和RIGHT报告率均随时间增加。我们发现AGREE II得分与RIGHT报告依从性之间存在高度正相关（r = 0.645，P < 0.001）。