PDF(Pubmed)
Abstract：
BACKGROUND: Asthma is one of the most frequent reasons children visit a general practitioner (GP). The diagnosis of childhood asthma is challenging, and a variety of diagnostic tests for asthma exist. GPs may refer to clinical practice guidelines when deciding which tests, if any, are appropriate, but the quality of these guidelines is unknown.
OBJECTIVE: To determine (i) the methodological quality and reporting of paediatric guidelines for the diagnosis of childhood asthma in primary care, and (ii) the strength of evidence supporting diagnostic test recommendations.
METHODS: Meta-epidemiological study of English-language guidelines from the United Kingdom and other high-income countries with comparable primary care systems including diagnostic testing recommendations for childhood asthma in primary care. The AGREE-II tool was used to assess the quality and reporting of the guidelines. The quality of the evidence was assessed using GRADE.
RESULTS: Eleven guidelines met the eligibility criteria. The methodology and reporting quality varied across the AGREE II domains (median score 4.5 out of 7, range 2-6). The quality of evidence supporting diagnostic recommendations was generally of very low quality. All guidelines recommended the use of spirometry and reversibility testing for children aged ≥5 years, however, the recommended spirometry thresholds for diagnosis differed across guidelines. There were disagreements in testing recommendations for 3 of the 7 included tests.
CONCLUSIONS: The variable quality of guidelines, lack of good quality evidence, and inconsistent recommendations for diagnostic tests may contribute to poor clinician adherence to guidelines and variation in testing for diagnosing childhood asthma.
OBJECTIVE: To determine (i) the methodological quality and reporting of paediatric guidelines for the diagnosis of childhood asthma in primary care, and (ii) the strength of evidence supporting diagnostic test recommendations.
METHODS: Meta-epidemiological study of English-language guidelines from the United Kingdom and other high-income countries with comparable primary care systems including diagnostic testing recommendations for childhood asthma in primary care. The AGREE-II tool was used to assess the quality and reporting of the guidelines. The quality of the evidence was assessed using GRADE.
RESULTS: Eleven guidelines met the eligibility criteria. The methodology and reporting quality varied across the AGREE II domains (median score 4.5 out of 7, range 2-6). The quality of evidence supporting diagnostic recommendations was generally of very low quality. All guidelines recommended the use of spirometry and reversibility testing for children aged ≥5 years, however, the recommended spirometry thresholds for diagnosis differed across guidelines. There were disagreements in testing recommendations for 3 of the 7 included tests.
CONCLUSIONS: The variable quality of guidelines, lack of good quality evidence, and inconsistent recommendations for diagnostic tests may contribute to poor clinician adherence to guidelines and variation in testing for diagnosing childhood asthma.
摘要：
背景：哮喘是儿童就诊全科医生（GP）的最常见原因之一。儿童哮喘的诊断具有挑战性，并且存在多种哮喘诊断测试。全科医生在决定哪些测试时可能会参考临床实践指南，如果有的话,是合适的,但是这些指南的质量是未知的。
目的：确定（i）在初级保健中诊断儿童哮喘的儿科指南的方法学质量和报告，（ii）支持诊断测试建议的证据强度。
方法：对英国和其他具有可比性的初级保健系统的高收入国家的英语指南进行的Meta流行病学研究，包括初级保健中儿童哮喘的诊断测试建议。AGREE-II工具用于评估指南的质量和报告。使用GRADE评估证据的质量。
结果：11个指南符合资格标准。方法和报告质量在AGREEII领域有所不同（7分的中位数为4.5，范围为2-6）。支持诊断建议的证据质量通常很低。所有指南都建议对5岁以上的儿童使用肺活量测定和可逆性测试。然而,推荐的肺活量测定诊断阈值因指南而异.在7项纳入测试中的3项测试建议存在分歧。
结论：指南的可变质量，缺乏高质量的证据，和不一致的诊断试验建议可能导致临床医生对指南的依从性差和儿童哮喘诊断试验的差异.
目的：确定（i）在初级保健中诊断儿童哮喘的儿科指南的方法学质量和报告，（ii）支持诊断测试建议的证据强度。
方法：对英国和其他具有可比性的初级保健系统的高收入国家的英语指南进行的Meta流行病学研究，包括初级保健中儿童哮喘的诊断测试建议。AGREE-II工具用于评估指南的质量和报告。使用GRADE评估证据的质量。
结果：11个指南符合资格标准。方法和报告质量在AGREEII领域有所不同（7分的中位数为4.5，范围为2-6）。支持诊断建议的证据质量通常很低。所有指南都建议对5岁以上的儿童使用肺活量测定和可逆性测试。然而,推荐的肺活量测定诊断阈值因指南而异.在7项纳入测试中的3项测试建议存在分歧。
结论：指南的可变质量，缺乏高质量的证据，和不一致的诊断试验建议可能导致临床医生对指南的依从性差和儿童哮喘诊断试验的差异.
