Published online May 2, 2005
PEDIATRICS Vol. 115 No. 5 May 2005, pp. 1378-1391 (doi:10.1542/peds.2004-0575)
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SPECIAL ARTICLE

Quality of Evidence-Based Pediatric Guidelines

Nicole Boluyt, MD*, Carsten R. Lincke, MD, PhD{ddagger} and Martin Offringa, MD, PhD*

* Department of Pediatrics, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
{ddagger} Department of Pediatrics, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, Netherlands

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.

Key Words: practice guidelines • evidence-based medicine • quality of health care • pediatric

Abbreviations: AGREE, Appraisal of Guidelines, Research, and Evaluation • AAP, American Academy of Pediatrics • SIGN, Scottish Intercollegiate Guidelines • CMA, Canadian Medical Association • NGC, National Guideline Clearinghouse • ICC, intraclass correlation coefficient

Accepted Sep 23, 2004.




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