Abstract：
The aim was to evaluate the quality of current venous leg ulcer (VLU) clinical practice guidelines (CPGs) to assist healthcare professionals in choosing an accessible high quality CPG to advise their practice, and to identify areas for improvement in future versions of current CPGs.
A systematic review of PubMed, Embase, online CPG databases, and reference lists of included CPGs was carried out. Full text CPGs published no earlier than 1998 reporting evidence based recommendations on VLU diagnosis and management in English were included. CPGs that were only available if purchased were excluded. Two reviewers identified eligible CPGs, extracted data, and assessed the quality independently using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument. Significant scoring discrepancies were discussed with a third reviewer.
Fourteen eligible CPGs were identified (1999-2016). The majority of CPGs originated from Europe or North America. Overall, there was good inter-reviewer reliability of scores with an intraclass correlation coefficient of 0.986 (95% confidence interval 0.979-0.991). No single CPG achieved the highest score in all six domains. Significant methodological heterogeneity was observed across VLU CPGs; however, consistently, poor performance was noted in domain 5, concerning CPG applicability.
Four CPGs were considered of adequate quality for clinical use. Consolidation of efforts to drive high quality, comprehensive VLU CPGs is necessary to reduce the number of and heterogeneity seen in currently published guidelines. Elements of methodological quality are lacking and a structured approach with use of checklists and CPG creation tools, such as AGREE II or others, may bolster rigour in future VLU CPGs.
A systematic review of PubMed, Embase, online CPG databases, and reference lists of included CPGs was carried out. Full text CPGs published no earlier than 1998 reporting evidence based recommendations on VLU diagnosis and management in English were included. CPGs that were only available if purchased were excluded. Two reviewers identified eligible CPGs, extracted data, and assessed the quality independently using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument. Significant scoring discrepancies were discussed with a third reviewer.
Fourteen eligible CPGs were identified (1999-2016). The majority of CPGs originated from Europe or North America. Overall, there was good inter-reviewer reliability of scores with an intraclass correlation coefficient of 0.986 (95% confidence interval 0.979-0.991). No single CPG achieved the highest score in all six domains. Significant methodological heterogeneity was observed across VLU CPGs; however, consistently, poor performance was noted in domain 5, concerning CPG applicability.
Four CPGs were considered of adequate quality for clinical use. Consolidation of efforts to drive high quality, comprehensive VLU CPGs is necessary to reduce the number of and heterogeneity seen in currently published guidelines. Elements of methodological quality are lacking and a structured approach with use of checklists and CPG creation tools, such as AGREE II or others, may bolster rigour in future VLU CPGs.
摘要：
目的是评估当前静脉性腿部溃疡（VLU）临床实践指南（CPG）的质量，以帮助医疗保健专业人员选择可访问的高质量CPG来为他们的实践提供建议。并确定当前CPG未来版本的改进领域。
对PubMed的系统评价，Embase,在线CPG数据库，并进行了所包括的CPG的参考列表。全文CPG不早于1998年发表，包括基于英语的VLU诊断和管理建议的报告证据。仅在购买时可用的CPG被排除在外。两名审阅者确定了合格的CPG，提取的数据，并使用《评估研究和评估指南II》（AGREEII）工具独立评估质量。与第三位审阅者讨论了重大评分差异。
确定了14个合格的CPG（1999-2016年）。大多数CPG起源于欧洲或北美。总的来说,研究者间评分的可靠性较好,组内相关系数为0.986(95%置信区间0.979-0.991).在所有六个领域中，没有一个CPG达到最高分。在VLUCPG中观察到显著的方法学异质性；然而，始终如一，关于CPG适用性，在第5域中注意到表现不佳。
四种CPG被认为具有足够的临床使用质量。巩固高质量驱动的努力，全面的VLUCPG对于减少当前发布的指南中看到的数量和异质性是必要的。缺乏方法论质量的要素，并且缺乏使用清单和CPG创建工具的结构化方法，例如AGREEII或其他，可能会加强未来VLUCPG的严谨性。
对PubMed的系统评价，Embase,在线CPG数据库，并进行了所包括的CPG的参考列表。全文CPG不早于1998年发表，包括基于英语的VLU诊断和管理建议的报告证据。仅在购买时可用的CPG被排除在外。两名审阅者确定了合格的CPG，提取的数据，并使用《评估研究和评估指南II》（AGREEII）工具独立评估质量。与第三位审阅者讨论了重大评分差异。
确定了14个合格的CPG（1999-2016年）。大多数CPG起源于欧洲或北美。总的来说,研究者间评分的可靠性较好,组内相关系数为0.986(95%置信区间0.979-0.991).在所有六个领域中，没有一个CPG达到最高分。在VLUCPG中观察到显著的方法学异质性；然而，始终如一，关于CPG适用性，在第5域中注意到表现不佳。
四种CPG被认为具有足够的临床使用质量。巩固高质量驱动的努力，全面的VLUCPG对于减少当前发布的指南中看到的数量和异质性是必要的。缺乏方法论质量的要素，并且缺乏使用清单和CPG创建工具的结构化方法，例如AGREEII或其他，可能会加强未来VLUCPG的严谨性。
