目的:确定介入医学学会发布的指南的有效性。
方法:我们回顾了美国支气管和介入肺病学协会(AABIP)的介入医学亚专业学会网站,美国诊断和介入肾病学会(ASDIN),美国胃肠内窥镜学会(ASGE),和心血管造影和介入协会(SCAI)截至2012年11月15日,为已发布的介入指南。该研究于2012年11月15日至2013年1月1日进行。AABIP没有发布指南,因此,我们对美国胸科学会和美国胸内科医师学会指南进行了综述.所有指南都经过了分级证据的审查,用于对证据进行评级的方法,以及利益冲突(COI)的披露。
结果:在评估的153个介入指南中,4是重复的。46%的指南(149个中的69个)使用7种不同的方法对证据质量进行评分。ASGE对71%的指南(65个中的46个)进行了评分,而SCAI为29%(78个中的23个),ASDIN(n=4)和肺社会(n=2)为0。在审查的3425项建议中,11%(n=364)得到A级支持,42%(n=1432),B级,48%(n=1629)按C级划分。指南的平均年龄为5.2岁。此外,62%的准则(149个中的92个)没有对COI发表评论;当披露时,91%的指南(57个中的52个)报告了COI。总的来说,45%的作者报告了1827年的COIs(697人中的317人),每位作者平均5.8个COI。
结论:大多数介入指南未能对证据进行分级。当存在时,大多数指南使用质量较低的证据.此外,大多数准则都没有披露COI。评论时,许多COIs都在场。未来的指导方针应该明确规定证据的质量,使用标准分级系统,对潜在偏见保持透明,并提供频繁的更新。
OBJECTIVE: To determine the validity of guidelines published by interventional medical societies.
METHODS: We reviewed the interventional medicine subspecialty society websites of the American Association for Bronchology and Interventional Pulmonology (AABIP), American Society of Diagnostic and Interventional Nephrology (ASDIN), American Society for Gastrointestinal Endoscopy (ASGE), and Society for Cardiovascular Angiography and Interventions (SCAI) as of November 15, 2012, for published interventional guidelines. The study was performed between November 15, 2012, and January 1, 2013. The AABIP did not publish guidelines, so American Thoracic Society and American College of Chest Physicians
guidelines were reviewed. All the guidelines were reviewed for graded levels of evidence, methods used to grade the evidence, and disclosures of conflicts of interest (COIs).
RESULTS: Of 153 interventional guidelines evaluated, 4 were duplicates. Forty-six percent of guidelines (69 of 149) graded the quality of evidence using 7 different methods. The ASGE graded 71% of guidelines (46 of 65) compared with 29% (23 of 78) by the SCAI and 0 by the ASDIN (n=4) and the pulmonary societies (n=2). Of the 3425 recommendations reviewed, 11% (n=364) were supported by level A, 42% (n=1432) by level B, and 48% (n=1629) by level C. The mean age of the
guidelines was 5.2 years. Additionally, 62% of the
guidelines (92 of 149) failed to comment on COIs; when disclosed, 91% of
guidelines (52 of 57) reported COIs. In total, 1827 COIs were reported by 45% of the authors (317 of 697), averaging 5.8 COIs per author.
CONCLUSIONS: Most of the interventional guidelines failed to grade the evidence. When present, most
guidelines used lower-quality evidence. Furthermore, most
guidelines failed to disclose COIs. When commented on, numerous COIs were present. Future guidelines should clearly state the quality of evidence, use a standard grading system, be transparent regarding potential biases, and provide frequent updates.