Arents Bernd W M, van Zuuren Esther J, Vermeulen Sofieke, Schoones Jan W, Fedorowicz Zbys
Dutch Association for People with Atopic Dermatitis, Nijkerk, the Netherlands.
Dermatology Department, Leiden University Medical Centre, Leiden, the Netherlands.
Br J Dermatol. 2022 May;186(5):792-802. doi: 10.1111/bjd.20972.
Clinical practice guidelines (CPGs) are essential in delivering optimum healthcare, such as for atopic dermatitis (AD), a highly prevalent skin disease. Although many CPGs are available for AD, their quality has not been critically appraised.
To identify CPGs on AD worldwide and to assess with validated instruments whether those CPGs are clear, unbiased, trustworthy and evidence based (CUTE).
We searched MEDLINE, Embase, PubMed, Web of Science, Cochrane Library, Emcare, Epistemonikos, PsycINFO and Academic Search Premier for CPGs on AD published between 1 April 2016 and 1 April 2021. Additionally we hand searched prespecified guideline resources. Screening, data extraction and quality assessment of eligible guidelines were independently carried out by two authors. Instruments used for quality assessment were the AGREE II Reporting Checklist, the US Institute of Medicine (IOM) criteria of trustworthiness and Lenzer's Red Flags.
Forty CPGs were included, mostly from countries with a high sociodemographic index. The reporting quality varied enormously. Three CPGs scored 'excellent' on all AGREE II domains and three scored 'poor' on all domains. We found no association between AGREE II scores and a country's gross domestic product. One CPG fully met all nine IOM criteria and two fully met eight. Three CPGs had no red flags. 'Applicability' and 'rigour of development' were the lowest scoring AGREE II domains; 'external review', 'updating procedures' and 'rating strength of recommendations' were the IOM criteria least met; and most red flags were for 'limited or no involvement of methodological expertise' and 'no external review'. Management of conflicts of interest (COIs) appeared challenging. When constructs of the instruments overlapped, they showed high concordance, strengthening our conclusions.
Overall, many CPGs are not sufficiently clear, unbiased, trustworthy or evidence based (CUTE) and lack applicability. Therefore improvement is warranted, for which using the AGREE II instrument is recommended. Some improvements can be easily accomplished through robust reporting. Others, such as transparency, applicability, evidence foundation and managing COIs, might require more effort.
临床实践指南（CPG）对于提供优质医疗保健至关重要，例如对于特应性皮炎（AD）这种高度常见的皮肤病。尽管有许多针对AD的CPG，但它们的质量尚未得到严格评估。
识别全球范围内关于AD的CPG，并使用经过验证的工具评估这些CPG是否清晰、无偏倚、值得信赖且基于证据（CUTE）。
我们在MEDLINE、Embase、PubMed、Web of Science、Cochrane图书馆、Emcare、Epistemonikos、PsycINFO和Academic Search Premier中检索了2016年4月1日至2021年4月1日期间发表的关于AD的CPG。此外，我们还手动检索了预先指定的指南资源。两名作者独立进行合格指南的筛选、数据提取和质量评估。用于质量评估的工具包括AGREE II报告清单、美国医学研究所（IOM）的可信度标准和Lenzer的警示标志。
纳入了40项CPG，大多数来自社会人口统计学指数较高的国家。报告质量差异极大。三项CPG在AGREE II的所有领域得分“优秀”，三项在所有领域得分“差”。我们发现AGREE II得分与一个国家的国内生产总值之间没有关联。一项CPG完全符合所有九项IOM标准，两项完全符合八项。三项CPG没有警示标志。“适用性”和“制定的严谨性”是AGREE II得分最低的领域；“外部评审”、“更新程序”和“推荐强度评级”是IOM标准中最不符合的；大多数警示标志是关于“方法学专业知识的参与有限或没有参与 ”和“没有外部评审”。利益冲突（COI）的管理似乎具有挑战性。当工具的结构重叠时，它们显示出高度一致性，加强了我们的结论。
总体而言，许多CPG不够清晰、无偏倚、值得信赖或基于证据（CUTE），并且缺乏适用性。因此有必要进行改进，建议使用AGREE II工具。一些改进可以通过强有力的报告轻松实现。其他方面，如透明度、适用性、证据基础和COI管理，可能需要更多努力。
