目的:目前的内窥镜检查质量指南主要集中在癌症筛查相关指标上,这些指标不适用于儿科人群。通过国际儿科内窥镜质量改进网络(PEnQuIN),儿科内镜手术的质量标准和指标由美国胃肠内镜学会(ASGE)制定和认可.
方法:评估和评估指南II仪器指导的PEnQuIN成员,来自代表11个国家的31个中心,生成和完善拟议的质量标准和指标。证据质量和建议强度根据建议评估等级进行评级。发展,和评价方法。通过迭代的在线Delphi流程寻求关于报告要素的共识。
结果:49项质量标准和47项指标,包括儿科内窥镜检查设施,程序,和内窥镜师,以及纳入儿科内窥镜检查报告所必需的30个报告要素达成共识.定义了与小儿下内镜检查相关的3项关键指标的最低可接受标准:末端回肠插管率≥85%,盲肠插管率≥90%,充分的肠道准备率≥80%。有强烈的共识,末端回肠插管,而不是盲肠插管,是确保儿童高质量内镜护理不可或缺的一部分。
结论:PEnQuIN指南建立了针对儿科内窥镜检查的有临床意义的指标的国际协议,可用于促进安全,高品质,以患者和家庭为中心的内窥镜护理。往前走,建议所有参与儿童内窥镜检查服务的提供者和设施采用PEnQuIN标准,指标,以及这些ASGE认可的指南中概述的关键报告要素。
Current endoscopy quality
guidelines largely focus on cancer screening-related metrics that are not applicable to pediatric populations. Through an international Pediatric Endoscopy Quality Improvement Network (PEnQuIN), quality standards and indicators for pediatric endoscopic procedures were developed and endorsed by the American Society for Gastrointestinal Endoscopy (ASGE).
The Appraisal of
Guidelines for REsearch and Evaluation II instrument guided PEnQuIN members, from 31 centers representing 11 countries, in generating and refining proposed quality standards and indicators. Quality of evidence and strength of recommendations were rated according to the Grading of Recommendation Assessment, Development, and Evaluation approach.
Consensus on reporting elements was sought with an iterative online Delphi process.
Forty-nine quality standards and 47 indicators, encompassing pediatric endoscopy facilities, procedures, and endoscopists, as well as 30 reporting elements essential for inclusion within a pediatric endoscopy report reached
consensus. Minimal acceptable standards were defined for 3 key indicators related to pediatric lower endoscopy: terminal ileal intubation rate ≥85%, cecal intubation rate ≥90%, and rate of adequate bowel preparation ≥80%. There was strong
consensus that terminal ileal intubation, rather than cecal intubation, is integral to ensuring high-quality endoscopic care in children.
The PEnQuIN guidelines establish international agreement on clinically meaningful metrics tailored to pediatric endoscopy that can be used to promote safe, high-quality, patient- and family-centered endoscopic care. Moving forward, it is recommended that all providers and facilities involved in endoscopy service for children adopt the PEnQuIN standards, indicators, and key reporting elements outlined in these ASGE-endorsed guidelines.