Clinical Practice Guidelines in the Management of Pediatric Foreign Body Aspiration and Ingestion: A Systematic Evaluation Using the AGREE II Instrument

Abstract

Purpose Several clinical practice guidelines (CPGs) have been produced to optimize diagnosis and management of pediatric foreign body aspiration and ingestion. However, to date there have been no critical evaluations of their methodological rigor or quality. Herein we address this need via the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument. Methods A literature search of Embase, MEDLINE via PubMed, and Scopus was performed up until February 25, 2021. Identified CPGs were then assessed by four independent reviewers trained in AGREE II. A scaled domain score of > 60% was indicated as satisfactory quality. Intraclass correlation coefficients (ICC) were calculated to assess inter-reviewer agreement. Results 11 guidelines were assessed with only one being classified as high quality and others being either average (two) or low quality (eight). Domain 4 (clarity of presentation) achieved the highest mean score (66.41% ± 13.33%), while domain 5 (applicability) achieved the lowest score (10.80% ± 10.37%). ICC analysis revealed generally strong agreement between reviewers with a range of 0.60–0.98. Conclusion Quality appraisal using the AGREE II instrument suggests that the methodologic rigor and quality of current guidelines for the diagnosis and management of pediatric foreign body aspiration and ingestion need significant improvement.