关键词: Clinical practice guidelines Critical appraisal Systematic review Urticaria

Mesh : Humans Australia Databases, Factual Dermatology Stakeholder Participation Urticaria / diagnosis therapy Practice Guidelines as Topic

来  源:   DOI:10.1016/j.jaip.2023.07.002

Abstract:
Management of urticaria can be optimized with clinical practice guidelines (CPGs). However, the quality of recent urticaria CPGs remains unclear.
To identify and appraise urticaria CPGs worldwide published in the last 5 years.
A search for relevant urticaria CPGs was conducted between January 1, 2017, and May 31, 2022, using the following databases: MEDLINE, Embase, National Institute for Health and Care Excellence (NICE) Evidence Search, Guidelines International Network, ECRI Guidelines Trust, Australian Clinical Practice Guidelines, Trip Medical Database, and DynaMed. The included CPGs were critically appraised using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument, Lenzer et al\'s red flags, and the Institute of Medicine (IOM) criteria of trustworthiness.
We included 21 urticaria CPGs. Most guidelines reviewed treatment recommendations of chronic spontaneous urticaria. The majority of guidelines were from European and Asian countries with high and high-middle sociodemographic index, written in English, and openly accessible. Seventeen guidelines (81%) had at least 1 AGREE II domain rated poor quality. Applicability, rigor of development, and stakeholder involvement were the 3 AGREE II domains that scored the lowest across guidelines. Appraisal with Lenzer et al\'s red flags showed that 18 guidelines (86%) raised at least 1 red flag indicating potential bias. The top 3 domains raising red flags were: no inclusion of nonphysician experts/patient representative/community stakeholders, no or limited involvement of a methodologist in the evaluation of evidence, and lack of external review. Based on IOM\'s criteria of trustworthiness, 20 guidelines (95%) had 1 or more criteria that did not meet best practice standards. The 3 domains with the highest number of best practice standards not met were updating procedures, rating strength of recommendations, and external review. Guidelines scored highest for the AGREE II domains of defining scope and purpose and clarity of presentation, and had the most fully met IOM\'s best practice standard for articulation of recommendations. However, only 1 urticaria CPG by NICE was identified as rigorously developed across all 3 appraisal tools.
The quality of urticaria CPGs in the last 5 years varied widely. Only the NICE urticaria guideline consistently demonstrated excellent quality, high trustworthiness, and low risk of bias. Use of a rigorous framework to rate certainty of evidence and grade strength of recommendation, involvement of methodologists, stakeholder engagement with external review, and clear guidance for updating can help improve the quality of future CPGs.
摘要:
背景:荨麻疹的治疗可以根据临床实践指南(CPG)进行优化。然而,近期荨麻疹CPG的质量尚不清楚.
目的:鉴定和评价近5年全球发表的荨麻疹CPG。
方法:在2017年1月1日至2022年5月31日之间使用以下数据库进行了相关荨麻疹CPG的搜索:MEDLINE,Embase,国家健康与护理卓越研究所(NICE)证据搜索,国际网络准则,ECRI准则信托,澳大利亚临床实践指南,TripMedicalDatabase,和DynaMed.使用《评估研究与评估指南》(AGREE)II工具对所包括的CPG进行了严格评估,伦泽尔的红旗,和美国医学研究所(IOM)的可信赖性标准。
结果:我们纳入了21例荨麻疹CPG。大多数指南回顾了慢性自发性荨麻疹的治疗建议。大多数指南来自社会人口指数高和中高的欧洲和亚洲国家,用英语写的,并且可以公开访问。17个指南(81%)至少有一个AGREEII域名被评为“质量差”。适用性,发展的严谨性,和利益相关者参与是在指南中得分最低的三个AGREEII领域。使用Lenzer的危险信号进行评估显示,有18个指南(86%)提出了至少一个危险信号,表明潜在的偏见。引发危险信号的前三个领域是:不包括非医师专家/患者代表/社区利益相关者,方法学家不参与或有限地参与证据评估,缺乏外部审查。根据国际移民组织的可信度标准,20个指南(95%)有≥一个标准不符合最佳实践标准。“未达到”最佳实践标准数量最多的三个域是:更新程序,建议的评级强度,和外部审查。在定义范围和目的以及表述清晰度的AGREEII领域中,准则得分最高,并且具有最“完全满足”的IOM最佳实践标准,用于阐明建议。然而,在所有三个评估工具中,只有一个由NICE确定为严格开发的荨麻疹CPG.
结论:过去5年荨麻疹的质量差异很大。只有NICE荨麻疹指南始终如一地表现出卓越的品质,高可信度,低偏见风险。使用严格的框架来评估证据的确定性和推荐的等级强度,方法学家的参与,利益相关者参与外部审查,明确的更新指导可以帮助提高未来CPG的质量。
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