这项研究旨在评估新生儿和儿童听力筛查的全球指南或共识声明的质量。以及比较其他国家和中国的各种指导方针。
进行了PROSPERO注册系统评价(编号CRD42021242198)。多个电子数据库和政府网站,包括PubMed,EMBASE,WebofScience,中部,科克伦图书馆,和BMJ最佳实践从一开始一直搜索到2021年5月。最新的国家和国际准则,共识声明,技术规格,以及有关新生儿或儿童听力筛查的建议,这些建议已在中文或英文医学期刊或其他地方发表,并在线提供完整版本。以下信息由两名审稿人独立提取进行比较分析:标题,作者,出版年份,国家,来源组织,以及主要的关键建议,使用分配证据水平和建议强度的系统。准则的质量由三名独立审核员使用《评估研究和评价准则》进行评估,第二版。计算组内相关系数(ICC)以评估审稿人之间的协议。
我们评估了15个新生儿和6个儿童听力筛查指南,分别。大多数新生儿指南推荐1-3-6指南和出院前筛查;然而,具体的筛选时间不同。93.33%的新生儿听力指南建议对健康婴儿进行“初级筛查-重新筛查-诊断-干预”,而73.33%的指南建议对新生儿重症监护病房(NICU)的新生儿进行“初始筛查-诊断-干预”;33.33%的新生儿听力指南建议初始筛查覆盖率>95%,而46.66%的人没有提及。Further,26.66%的新生儿听力指南建议将诊断的转诊率在4%以内,而60%的人没有提及。关于儿童听力筛查指南,筛查人群因指南而异(年龄范围:0~9岁);大多数指南建议对所有学龄前儿童进行儿科听力筛查.只有50%的指南规定了筛查和重新筛查技术,包括纯音听力筛查,OAE,鼓室测压,和其他人。“演示文稿的清晰度”领域获得了最高的平均得分,在新生儿和儿童指南中,最低的是“编辑独立性”。新生儿听力筛查指南的总分从3分(2018年欧洲)到7分(2019年美国),平均得分为5.33分。儿童听力筛查指南的平均得分为4.78,得分从4分(2017年英格兰,2012年欧洲,2016年世卫组织)至6.67(2011年美国)。ICC分析显示,21条指南(>0.75)的一致性非常好。
这些结果表明,新生儿听力筛查指南的质量优于儿童期。比较分析表明,中国新生儿和儿科听力筛查方案的建议与国际主流观点一致。此外,这一分析表明,“编辑独立性”和“利益相关者参与”有最大的改进机会。这些结果可能有助于提高临床实践中听力筛查指南的质量,并指导基于证据的更新。
This study aimed to assess the quality of global
guidelines or
consensus statements for newborn and childhood
hearing screening, as well as to compare various
guidelines between other countries and China.
A PROSPERO registered systematic review (number CRD42021242198) was conducted. Multiple electronic databases and government websites including PubMed, EMBASE, Web of Science, CENTRAL, Cochrane Library, and BMJ Best Practice were searched from inception until May 2021. The latest national and international
guidelines,
consensus statements, technical specifications, and recommendations regarding newborn or childhood hearing screening that were published in Chinese or English medical journals or elsewhere with the full version available online. The following information was extracted independently by two reviewers for comparative analysis: titles, authors, publication year, country, the source organization, and main key recommendations using systems for assigning the level of evidence and strength of recommendations. The quality of the guidelines was assessed by three independent reviewers using the Appraisal of Guidelines for Research and Evaluation, 2nd edition. Intraclass correlation coefficients (ICCs) were calculated to assess among-reviewer agreement.
We assessed 15 newborn and 6 childhood
hearing screening
guidelines, respectively. Most newborn guidelines recommend the 1-3-6 guidelines and pre-discharge screening; however, the specific screening times differ. 93.33% of newborn hearing guidelines recommend \"primary screening-re-screening-diagnosis-intervention\" for well-babies while 73.33% of the guidelines recommend \"initial screening-diagnosis-intervention\" for newborns in neonatal intensive care unit (NICU); 33.33% of the newborn hearing guidelines recommended initial screening coverage of > 95% while 46.66% did not mention it. Further, 26.66% of the newborn hearing guidelines recommended a referral rate to diagnosis within 4% while 60% did not mention it. Regarding childhood
hearing screening
guidelines, the screening populations differed across
guidelines (age range: 0-9 years); most guidelines recommend pediatric hearing screening for all preschoolers. Only 50% of the guidelines specify screening and re-screening techniques, including pure-tone hearing screening, OAE, tympanometry, and others. The \"Clarity of Presentation\" domain achieved the highest mean score, and the lowest was \"Editorial Independence\" both in newborn and childhood guidelines. Overall score of newborn hearing screening guidelines ranged from 3 (2018 Europe) to 7 (2019 America), with an average score of 5.33. Average score of childhood hearing screening guidelines was 4.78, with the score ranging from 4 (2017 England, 2012 Europe, 2016 WHO) to 6.67 (2011 America). ICC analysis revealed excellent agreement across 21 guidelines (> 0.75).
These findings indicated newborn hearing screening guidelines had superior quality over childhood ones. Comparative analysis suggested that recommendations of the Chinese newborn and pediatric hearing screening protocols are consistent with the mainstream international opinion. Moreover, this analysis demonstrated that \"Editorial Independence\" and \"Stakeholder Involvement\" have the greatest opportunities for improvement. These results may help to advance the quality of hearing screening guidelines in clinical practice and guide evidence-based updates.