Guías de práctica clínica en esquizofrenia: evaluación mediante AGREE II

Critical appraisal and comparison of recommendations of clinical practice guidelines for the treatment of schizophrenia in children and adolescents: a methodological survey

“…There was also the variability of evidence appraisal systems used. The same problem has been found in other critical appraisals of CPGs for mental health disorders 38 40–43. This might indicate that, even though the GRADE approach is recommended in the development of this type of document,44 it seems that it is still not well established in the CPGs’ development processes.…”

“…The same problem has been found in other critical appraisals of CPGs for mental health disorders. 38 40–43 This might indicate that, even though the GRADE approach is recommended in the development of this type of document, 44 it seems that it is still not well established in the CPGs’ development processes. The use of GRADE in future developments could help mitigate this inconsistency and the standardisation of evidence appraisal could benefit decision-makers, helping them compare and use the best available evidence.…”

“…In our results, the first noticeable aspect was that most of the selected CPGs were from high-income countries. This lack of guidance from middle-low-income and low-income countries was present in other critical appraisals for schizophrenia 37 38. The ADAPTE process, used in one of the high-income countries’ CPGs, could help fasten the publication of guidelines in less resourceful contexts due to its flexible nature and possibility of being used by groups with different amounts of resources 39…”

“…At the AGREE II assessment, the NICE and the Canadian CPGs28–34 completed the criteria to be considered of high quality. The NICE CPG for children had many recommendations adapted from the adult version,28 which, in the assessments of CPGs for the treatment of schizophrenia in adults conducted by Bradford et al 38 and Keating et al ,37 was also the highest score. The Canadian CPG adapted most recommendations from the NICE CPG, which can be one of the reasons for it also having high scores.…”

“…Overall, the domain with the worst scores in the AGREE II assessment was domain 5 of applicability. This domain usually presents lower scores in critical appraisals 19 37 38 41–43 45. This is a controversial domain because information about implementation can be found in other documents outside the guideline scope and this can interfere with the scoring of the domain 46.…”