Quality of Evidence-Based Pediatric Guidelines
10.1542/peds.2004-0575
Crossref journal-article
American Academy of Pediatrics (AAP)
Pediatrics (417)
Abstract

Objective. To identify evidence-based pediatric guidelines and to assess their quality.Methods. We searched Medline, Embase, and relevant Web sites of guideline development programs and national pediatric societies to identify evidence-based pediatric guidelines. A list with titles of identified guidelines was sent to 51 leading pediatricians in the Netherlands, who were asked to select the 5 most urgent topics for guideline development. Three pediatrician reviewers appraised the available guidelines on the 10 most frequently mentioned topics with the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument.Results. A total of 215 evidence-based pediatric guidelines were identified; of these, 17 guidelines on the 10 most frequently mentioned topics were appraised. The AGREE instrument rates guidelines among 6 domains. For the scope and purpose domain, the mean score was 84% of the maximal mark. For stakeholder involvement, the mean score was 42%, with 12 guidelines (71%) scoring <50%. For rigor of development, the mean score was 54%, with 5 guidelines (29%) scoring <50%. For clarity and presentation, the mean score was 78%, with 4 guidelines (24%) scoring <50%. For applicability and editorial independence, performance was poor, with mean scores of 19% and 40%, respectively. Low scores were partly attributable to poor reporting. After considering all domain scores, the reviewers recommended 14 of 17 guidelines (82%) to be used in local practice.Conclusions. The current volume of pediatric guidelines categorized as evidence based in popular databases is large. Overall, these guidelines scored well, compared with other studies on guideline quality in fields outside pediatrics, when assessed for quality with the AGREE instrument. This holds especially for guidelines published or endorsed by the American Academy of Pediatrics or registered in the National Guideline Clearinghouse.

Bibliography

Boluyt, N., Lincke, C. R., & Offringa, M. (2005). Quality of Evidence-Based Pediatric Guidelines. Pediatrics, 115(5), 1378–1391.

Authors 3
  1. Nicole Boluyt (first)
  2. Carsten R. Lincke (additional)
  3. Martin Offringa (additional)
References 37 Referenced 54
  1. Institute of Medicine. Guidelines for Clinical Practice: From Development to Use. Washington, DC: National Academy Press; 1992
  2. NICU study: best practices are not always followed. Healthcare Benchmarks Qual Improv. 2003;10:68–69
  3. Grol R. Improving the quality of medical care: building bridges among professional pride, payer profit, and patient satisfaction. JAMA. 2001;286:2578–2585 (10.1001/jama.286.20.2578)
  4. Furdon SA, Eastman M, Benjamin K, Horgan MJ. Outcome measures after standardized pain management strategies in postoperative patients in the neonatal intensive care unit. J Perinat Neonatal Nurs. 1998;12:58–69 (10.1097/00005237-199806000-00009)
  5. Grimshaw JM, Russell IT. Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluations. Lancet. 1993;342:1317–1322 (10.1016/0140-6736(93)92244-N)
  6. Kaempf JW, Campbell B, Sklar RS, et al. Implementing potentially better practices to improve neonatal outcomes after reducing postnatal dexamethasone use in infants born between 501 and 1250 grams. Pediatrics. 2003;111(4). Available at: www.pediatrics.org/cgi/content/full/111/4/e534 (10.1542/peds.111.SE1.e534)
  7. Kuzma-O'Reilly B, Duenas ML, Greecher C, et al. Evaluation, development, and implementation of potentially better practices in neonatal intensive care nutrition. Pediatrics. 2003;111(4). Available at: www.pediatrics.org/cgi/content/full/111/4/e461 (10.1542/peds.111.SE1.e461)
  8. Perlstein PH, Kotagal UR, Bolling C, et al. Evaluation of an evidence-based guideline for bronchiolitis. Pediatrics. 1999;104:1334–1341 (10.1542/peds.104.6.1334)
  9. Turley K, Tyndall M, Roge C, et al. Critical pathway methodology: effectiveness in congenital heart surgery. Ann Thorac Surg. 1994;58:57–63 (10.1016/0003-4975(94)91072-3)
  10. Wirtschafter DD, Jones KR, Thomas JT. Using health care outcomes to improve patient care in the NICU. Jt Comm J Qual Improv. 1994;20:57–65 (10.1016/S1070-3241(16)30044-X)
  11. Cluzeau FA, Littlejohns P, Grimshaw JM, Feder G, Moran SE. Development and application of a generic methodology to assess the quality of clinical guidelines. Int J Qual Health Care. 1999;11:21–28 (10.1093/intqhc/11.1.21)
  12. Shaneyfelt TM, Mayo-Smith MF, Rothwangl J. Are guidelines following guidelines? The methodological quality of clinical practice guidelines in the peer-reviewed medical literature. JAMA. 1999;281:1900–1905 (10.1001/jama.281.20.1900)
  13. Ward JE, Grieco V. Why we need guidelines for guidelines: a study of the quality of clinical practice guidelines in Australia. Med J Aust. 1996;165:574–576 (10.5694/j.1326-5377.1996.tb138645.x)
  14. Graham ID, Beardall S, Carter AO, et al. What is the quality of drug therapy clinical practice guidelines in Canada?CMAJ. 2001;165:157–163
  15. Grilli R, Magrini N, Penna A, Mura G, Liberati A. Practice guidelines developed by specialty societies: the need for a critical appraisal. Lancet. 2000;355:103–106 (10.1016/S0140-6736(99)02171-6)
  16. AGREE Collaboration. Development and validation of an international appraisal instrument for assessing the quality of clinical practice guidelines: the AGREE project. Qual Saf Health Care. 2003;12:18–23 (10.1136/qhc.12.1.18)
  17. Byrt T, Bishop J, Carlin JB. Bias, prevalence and κ. J Clin Epidemiol. 1993;46:423–429 (10.1016/0895-4356(93)90018-V)
  18. Hoehler FK. Bias and prevalence effects on κ viewed in terms of sensitivity and specificity. J Clin Epidemiol. 2000;53:499–503 (10.1016/S0895-4356(99)00174-2)
  19. Harpole LH, Kelley MJ, Schreiber G, Toloza EM, Kolimaga J, McCrory DC. Assessment of the scope and quality of clinical practice guidelines in lung cancer. Chest. 2003;123(suppl):7S–20S (10.1378/chest.123.1_suppl.7S)
  20. Shekelle PG, Ortiz E, Rhodes S, et al. Validity of the Agency for Healthcare Research and Quality clinical practice guidelines: how quickly do guidelines become outdated?JAMA. 2001;286:1461–1467 (10.1001/jama.286.12.1461)
  21. Felt B, Wise CG, Olson A, Kochhar P, Marcus S, Coran A. Guideline for the management of pediatric idiopathic constipation and soiling: multidisciplinary team from the University of Michigan Medical Center in Ann Arbor. Arch Pediatr Adolesc Med. 1999;153:380–385 (10.1001/archpedi.153.4.380)
  22. Baker SS, Liptak GS, Colletti RB, et al. Constipation in infants and children: evaluation and treatment: a medical position statement of the North American Society for Pediatric Gastroenterology and Nutrition. J Pediatr Gastroenterol Nutr. 1999;29:612–626 (10.1097/00005176-199911000-00029)
  23. American Academy of Pediatrics, Committee on Quality Improvement, Subcommittee on Urinary Tract Infection. Practice parameter: the diagnosis, treatment, and evaluation of the initial urinary tract infection in febrile infants and young children. Pediatrics. 1999;103:843–852. (10.1542/peds.103.4.843)
  24. Children's Hospital Medical Center. Evidence-Based Clinical Practice Guideline for Patients 6 Years of Age or Less With a First Time Acute Urinary Tract Infection (UTI). Cincinnati, OH: Children's Hospital Medical Center; 1999. Available at: www.cincinnatichildrens.org/svc/alpha/h/health-policy/ev-based/uti.htm. Accessed March 21, 2005
  25. Schutzman SA, Barnes P, Duhaime AC, et al. Evaluation and management of children younger than two years old with apparently minor head trauma: proposed guidelines. Pediatrics. 2001;107:983–993 (10.1542/peds.107.5.983)
  26. American Academy of Pediatrics, American Academy of Family Physicians. Management of minor closed head injury in children. Pediatrics. 1999;104:1407–1415 (10.1542/peds.104.6.1407)
  27. Scottish Intercollegiate Guidelines Network. Early Management of Patients With a Head Injury: A National Clinical Guideline. Edinburgh, Scotland: Scottish Intercollegiate Guidelines Network; 2000. SIGN publication 46. Available at: www.sign.ac.uk/guidelines/fulltext/46/index.html. Accessed March 21, 2005
  28. Canadian Paediatric Society. Management of children with head trauma. CMAJ. 1990;142:949–952
  29. Metzger DL. A provincial protocol for the treatment of diabetic ketoacidosis in children. B C Med J. 1998;40:110–114
  30. Gralla RJ, Osaba D, Kris MG, et al. Recommendations for the use of antiemetics: evidence-based, clinical practice guidelines. American Society of Clinical Oncology. J Clin Oncol. 1999;17:2971–2994 (10.1200/JCO.1999.17.9.2971)
  31. American Society of Health-System Pharmacists. ASHP Therapeutic Guidelines on the Pharmacologic Management of Nausea and Vomiting in Adult and Pediatric Patients Receiving Chemotherapy or Radiation Therapy or Undergoing Surgery. Bethesda, MD: American Society of Health-System Pharmacists; 1999. Available at: www.ashp.org/bestpractices/index.cfm. Accessed March 21, 2005
  32. American Urological Association. The Management of Primary Vesicoureteral Reflux in Children. Linthicum, MD: American Urological Association; 1997
  33. Baraff LJ, Bass JW, Fleisher GR, et al. Practice guideline for the management of infants and children 0 to 36 months of age with fever without source: Agency for Health Care Policy and Research [published correction appears in Ann Emerg Med. 1993;22:1490]. Ann Emerg Med. 1993;22:1198–1210 (10.1016/S0196-0644(05)80991-6)
  34. Children's Hospital Medical Center. Evidence-Based Clinical Practice Guideline: Fever of Uncertain Source in Infants 60 Days of Age or Less. Cincinnati, OH: Children's Hospital Medical Center; 1998. Available at: www.cincinnatichildrens.org/svc/alpha/h//health-policy/ev-based/feveri.htm. Accessed March 21, 2005
  35. Slater M, Krug SE. Evaluation of the infant with fever without source: an evidence based approach. Emerg Med Clin North Am. 1999;17:97–126 (10.1016/S0733-8627(05)70049-3)
  36. Children's Hospital Medical Center. Evidence-Based Clinical Practice Guideline: Outpatient Evaluation and Management of Fever of Uncertain Source in Children 2 to 36 Months of Age. Cincinnati, OH: Children's Hospital Medical Center; 2000. Available at: www.cincinnatichildrens.org/svc/alpha/h/health-policy/ev-based/feverii.htm. Accessed March 21, 2005
  37. Canadian Paediatric Society. Management of the Febrile One- to 36-Month-Old Child With No Focus of Infection. Ottawa, Ontario, Canada: Canadian Paediatric Society; 1996 (reviewed 2000)
Dates
Type When
Created 20 years, 4 months ago (May 2, 2005, 3:38 p.m.)
Deposited 2 years, 4 months ago (May 3, 2023, 12:08 a.m.)
Indexed 3 months, 3 weeks ago (May 8, 2025, 9:11 a.m.)
Issued 20 years, 4 months ago (May 1, 2005)
Published 20 years, 4 months ago (May 1, 2005)
Published Online 20 years, 4 months ago (May 1, 2005)
Published Print 20 years, 4 months ago (May 1, 2005)
Funders 0

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@article{Boluyt_2005, title={Quality of Evidence-Based Pediatric Guidelines}, volume={115}, ISSN={1098-4275}, url={http://dx.doi.org/10.1542/peds.2004-0575}, DOI={10.1542/peds.2004-0575}, number={5}, journal={Pediatrics}, publisher={American Academy of Pediatrics (AAP)}, author={Boluyt, Nicole and Lincke, Carsten R. and Offringa, Martin}, year={2005}, month=may, pages={1378–1391} }