COVID-19 Evidence Alerts
from McMaster PLUSTM

Current best evidence for clinical care (more info)

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Treatment Li Q, Zhou Q, Xun Y, et al. Quality and consistency of clinical practice guidelines for treating children with COVID-19. Ann Transl Med. 2021 Apr;9(8):633. doi: 10.21037/atm-20-7000.

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 (recommend: 25%, not recommend: 45%, not report: 30%), interferon (recommend: 15%, not recommend: 50%, not report: 35%), glucocorticoids (recommend: 50%, not recommend: 20%, not report: 30%), and intravenous immune globulin (recommend: 35%, not recommend: 30%, not report: 35%). None of the guidelines cited clinical trials from children with COVID-19.

Conclusions: The methodological and reporting quality of guidelines for treating children with COVID-19 was not high. Recommendations were inconsistent across different guidelines. The supporting evidence from children with COVID-19 was very limited.

Discipline / Specialty Area Score
Emergency Medicine
Hospital Doctor/Hospitalists
Internal Medicine
Pediatric Emergency Medicine
Pediatric Hospital Medicine
Comments from MORE raters

Pediatric Emergency Medicine rater

The paper assesses the quality and consistency of guidelines for treating children with COVID-19. It should come as no surprise that these guidelines - developed on the fly in the face of incomplete understanding in an evolving pandemic - are not high quality and inconsistent with one another. I'm not sure this paper adds much to the care of these children or to our understanding of which guideline components would be important to include in any local or national guidelines.