Critical Review of the Scientific Evidence and Recommendations in COVID-19 Management Guidelines

Abstract

Background Little is known about the quality and potential impacts of the guidelines for COVID-19 management. Methods We systematically searched PubMed, Web of Science, Cochrane Library, guideline databases and specialty society Web sites to evaluate the quality of the retrieved guidelines using the Appraisal of Guidelines for Research and Evaluation II. Results A total of 66 guidelines were identified. Only 24% were categorized as “recommended” for clinical practice. The 211 identified recommendations for COVID-19 management were classified into four topics: respiratory support(27), ARDS management(31), anti-viral or immunomodulatory therapy(95), or other medicines(58). Only 63% and 56% recommendations were supported by, respectively, assessment of the strength of recommendation or level of evidence. There were notable discrepancies between the different guidelines regarding the recommendations on COVID-19 management. Conclusions The quality of the guidelines for COVID-19 management is heterogeneous, and the recommendations are rarely supported by evidence.

Most published systematic reviews of remdesivir for COVID-19 were redundant and lacked currency

“…Although several meta-research studies have explored different aspects of COVID-19 research, such as volume, characteristics, and quality [ 2 , 4 , 73 , 74 ], this is the first study to our knowledge that has focused on the extent of duplication and currency among published systematic reviews of one intervention. In addition, looking at which studies were included in the reviews allowed us to contrast the utility of systematic reviews with living guidelines for informing up-to-date decisions.…”

Predictors of Noninvasive Respiratory Support Failure in COVID-19 Patients: A Prospective Observational Study

“…NIV may be utilized as a first-line treatment as well as a follow-up therapy after HFNC [9]. NIV showed variable success rates, from 11% in milder cases to 80% in severely ill patients [6,9,15].…”

“…The best supportive treatment for AHRF caused by COVID-19 is still unknown. In general, the current guidelines are of poor quality and widely variable [9]. There are no clear recommendations about the indications for NIRS or which individuals will need endotracheal intubation and invasive care [10].…”

Characteristics of published/registered clinical trials on COVID-19 treatment: A systematic review

“…According to the guidelines from national and international organizations several medications have been more discussed for COVID-19 treatment. For instance, plasma therapy, LPV/r, tocilizumab, remdesivir, sofosbuvir-daclatasvir, corticosteroids, IFNs, ivermectin, and anti-thrombotics are frequently discussed in guidelines [12].…”