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

Qinyuan Li; Qi Zhou; Yangqin Xun; Hui Liu; Qianling Shi; Zijun Wang; Siya Zhao; Xiao Liu; Enmei Liu; Zhou Fu; Yaolong Chen; Zhengxiu Luo

doi:10.21037/atm-20-7000

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.

Authors

Qinyuan Li¹, Qi Zhou^{2

3}, Yangqin Xun³, Hui Liu⁴, Qianling Shi², Zijun Wang³, Siya Zhao⁴, Xiao Liu⁴, Enmei Liu¹, Zhou Fu¹, Yaolong Chen^{3

5

6

7

8

9}, Zhengxiu Luo¹

Affiliations

¹ Department of Respiratory Medicine Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China.
² The First School of Clinical Medicine, Lanzhou University, Lanzhou, China.
³ Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.
⁴ School of Public Health, Lanzhou University, Lanzhou, China.
⁵ Lanzhou University Institute of Health Data Science, Lanzhou, China.
⁶ WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou, China.
⁷ GIN Asia, Lanzhou, China.
⁸ Chinese GRADE Centre, Lanzhou, China.
⁹ Lanzhou University, an Affiliate of the Cochrane China Network, Lanzhou, China.

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 (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.

Keywords: Clinical practice guidelines (CPGs); Coronavirus Disease 2019 (COVID-19); children; consistency analysis; quality appraisal.