Anwar Shimaa A M, Elsakka Elham E, Khalil Mona, Ibrahim Afaf A G, ElBeheiry Ahmed, Mohammed Sohair Farouk, Omar Tarek E I, Amer Yasser S
Paediatric Neurology Unit, Faculty of Medicine, Paediatrics Department, Alexandria University, Alexandria, Egypt.
Faculty of Medicine, Community Medicine Department, Alexandria University, Alexandria, Egypt.
Pediatr Neurol. 2023 Apr;141:87-92. doi: 10.1016/j.pediatrneurol.2022.12.009. Epub 2023 Jan 7.
HYPOTHESIS AND/OR BACKGROUND: We recently updated and merged the adapted clinical practice guidelines (CPGs) for the diagnosis and treatment of children with epilepsy of a tertiary-level hospital. Medical knowledge is always evolving. As a result, it is critical to revisit the clinical standards on a frequent basis to ensure that the best services are offered to the target receivers. The purpose of this article was to update and merge the CPGs at Alexandria University Children Hospital (AUCH) for the diagnosis (2014) and treatment (2016) of children with epilepsy to unify and standardize the practice for better care and outcome.
This review and update CPG project was initiated by assembling a Guideline Review Group (GRG). The GRG conducted focus group discussions and decided to search any published updates of the recommendations of the previously identified high-quality and evidence-based CPG developed by the SIGN (Scottish Intercollegiate Guidelines Network) and to merge the two previous local CPGs under one comprehensive CPG for full management of epilepsy in children. The high quality of the selected source CPG from SIGN was based on quality assessment of CPGs undertaken previously using the Appraisal of Guidelines for Research and Evaluation II Instrument. The GRG followed the Checklist for the Reporting of Updated Guidelines (CheckUp), which is the CPG tool recommended by the Enhancing the Quality and Transparency of health Research Network for reporting of updated CPGs in addition to the RIGHT-Ad@pt Checklist for Adapted CPGs. The finalized updated CPG draft was sent to the external reviewer group topic experts.
The group updated 10 main categories of recommendations from one source CPG (SIGN). The recommendations included (1) epilepsy diagnosis; (2) recognition, identification, and referral; (3) pharmacological treatment of epilepsy and epilepsy syndromes; (4) nonpharmacological treatment of epilepsy and epilepsy syndromes; (5) managing pharmacoresistant epilepsy; (6) management of epilepsy in special groups; (7) medications; (8) children and caregiver education and support; (9) comorbidities and mortality; and (10) transitional care from pediatric to adult care services.
The finalized CPG provides evidence-based guidance to health care providers in AUCH for the diagnosis and management of epilepsy in children. The study also established the significance of a collaborative clinical and methodological expert group for the update of CPGs, as well as the usability of the "CheckUp" and "RIGHT-Ad@pt" CPG Tools.
假设和/或背景：我们最近更新并合并了一家三级医院儿童癫痫诊断与治疗的适应性临床实践指南（CPG）。医学知识一直在不断发展。因此，经常重新审视临床标准以确保为目标受众提供最佳服务至关重要。本文的目的是更新并合并亚历山德里亚大学儿童医院（AUCH）关于儿童癫痫诊断（2014年）和治疗（2016年）的CPG，以统一和规范实践，实现更好的护理和治疗效果。
通过组建指南审查小组（GRG）启动了本次CPG审查与更新项目。GRG进行了焦点小组讨论，并决定搜索由苏格兰校际指南网络（SIGN）制定的先前确定的高质量且基于证据的CPG建议的任何已发表更新内容，并将之前的两个本地CPG合并为一个全面的CPG，用于儿童癫痫的全面管理。从SIGN选定的源CPG的高质量基于先前使用《研究与评估指南评估II工具》对CPG进行的质量评估。GRG遵循了《更新指南报告清单》（CheckUp），这是健康研究网络提高质量和透明度推荐的CPG工具，用于报告更新的CPG，此外还遵循了适应性CPG的RIGHT-Ad@pt清单。最终确定的更新CPG草案被发送给外部审查小组的主题专家。
该小组更新了来自一个源CPG（SIGN）的10个主要类别的建议。这些建议包括：（1）癫痫诊断；（2）识别、确认和转诊；（3）癫痫及癫痫综合征的药物治疗；（4）癫痫及癫痫综合征的非药物治疗；（5）药物难治性癫痫的管理；（6）特殊群体中癫痫的管理；（7）药物；（8）儿童及照顾者教育与支持；（9）合并症与死亡率；（10）从儿科到成人护理服务的过渡性护理。
最终确定的CPG为AUCH的医疗服务提供者提供了关于儿童癫痫诊断和管理的循证指导。该研究还确立了临床和方法学协作专家组对CPG更新的重要性，以及“CheckUp”和“RIGHT-Ad@pt”CPG工具的实用性。
