Quality and consistency of clinical practice guidelines for treating children with COVID-19

Abstract

Background: The Coronavirus Disease 2019 (COVID-19) pandemic negatively affects children's health.Many guidelines have been developed for treating children with COVID-19. The quality of the existing guidelines and the consistency of recommendations remains unknown. Therefore, we aim to review the clinical practice guidelines (CPGs) for children with COVID-19 systematically.Methods: We systematically searched Medline, Embase, guideline-related websites, and Google. The Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool and Reporting Items for practice Guidelines in HealThcare (RIGHT) checklist were used to evaluate the methodological and reporting quality of the included guidelines, respectively. The consistency of recommendations across the guidelines and their supporting evidence were analyzed.Results: Twenty guidelines were included in this study. The mean AGREE II score and mean RIGHT reporting rate of the included guidelines were 37% (range, 22-62%) and 52% (range, 31-89%), respectively.As for methodological quality, no guideline was classified as high, one guideline (5%) moderate, and 19 (95%) low. In terms of reporting quality, one guideline (5%) was rated as high, 12 guidelines (60%) moderate, and seven (35%) low. Among included guidelines, recommendations varied greatly in the use of remdesivir

The rapid, massive growth of COVID-19 authors in the scientific literature

“…The quality of the published work was not assessed in our analysis, given the broad scope and huge diversity of the included papers. Nevertheless, many surveys of the quality of COVID-19 publications already exist [15,[25][26][27][28][29][30][31][32][33][34][35][36][37]. Although existing surveys of the quality of COVID-19 research do not cover all subfields of investigation and quality is often difficult to measure precisely, the consistent finding of the high prevalence of low-quality studies across very different types of study designs suggests that a large portion ( perhaps even the large majority) of the immense and rapidly growing COVID-19 literature may be of low quality.…”

Systematic Identification and Critical Appraisal of Pediatric COVID-19 Guidelines Applicable in India

“…Previous studies were either limited in focus or approach [ 20 , 21 ]. One study on 20 pediatric guidelines separately assessed their methodological as well as reporting quality [ 22 ], and found no guidelines having high quality. The methodological quality and reporting quality of most guidelines went hand-in-hand, suggesting that low methodological quality was not related to inadequate reporting alone [ 22 ].…”

“…This view is inappropriate for two reasons. Studies have shown that guidelines developed with inadequate methodology resulted in discrepant recommendations even for a limited set of interventions [ 22 , 26 ], often promoting therapies later conclusively proven to be ineffective [ 22 , 27 ] and recommended not to be used. The ethical, clinical and economic consequences of such practices have also been highlighted [ 1 ].…”

Guidelines developed under pressure. The case of the COVID-19 low-quality “rapid” guidelines and potential solutions

“…Although we could have expected that the quality would improve over time, this was not the case. Several authors have shown how the quality of guidelines published later in the pandemic and even more recently is still suboptimal [8] , [9] , [10] , [11] , [12] .…”