Methodological and reporting quality of pediatric clinical practice guidelines: a systematic review

Background: Pediatric clinical practice guidelines (CPGs) can provide systematically developed clinical recommendations to guide pediatric clinicians and patients making decisions. This study aims to assess the methodological and reporting quality of pediatric CPGs. Methods: We performed a systematic literature search of MEDLINE from 1 January 1990 to 2 April 2020 to identify pediatric CPGs published in the ten highest-impact pediatric journals and four highest-impact general medical journals. Two researchers evaluated the methodological and reporting quality of pediatric CPGs using the Appraisal of Guidelines Research and Evaluation (AGREE) II instrument and Reporting Items for Practice Guidelines in Health care (RIGHT) checklist. We calculated the mean AGREE II scores and compliance to RIGHT overall, and for each domain of the respective tools. We compared the methodological and reporting quality by different time periods and calculated the correlation between the AGREE II score and compliance to RIGHT. Results: A total of 159 pediatric CPGs were identified. The mean (+/- standard deviation) scores for the six domains of the AGREE II instrument were as follows: scope and purpose 74.5%+/- 14.2%, stakeholder involvement 42.7%+/- 16.2%, rigour of development 18.7%+/- 14.2%, clarity of presentation 56.5%+/- 17.0%, applicability 8.9%+/- 12.7% and editorial independence 25.2%+/- 34.6%. The overall assessment score was 37.8%+/- 12.4%. The mean compliance to RIGHT items in the seven domains of the checklist were: basic information 73.6%+/- 14.9%, background 67.1%+/- 16.4%, evidence 32.7%+/- 27.2%, recommendations 32.4%+/- 22.5%, review and quality assurance 22.9%+/- 40.4%, funding and declaration and management of interests 24.1%+/- 36.3%, and other information 45.3%+/- 30.1%. The overall reporting rate for RIGHT was 46.4%+/- 16.6%. Both the AGREE II scores and RIGHT reporting rates increased over time. We found a high positive correlation between AGREE II scores and RIGHT reporting compliance (r =0.645, P<0.001). Discussion: The methodological and reporting quality of pediatric CPGs have improved over time, but remain still suboptimal and needs to be further improved. An international database of pediatric guidelines is urgently needed to identify and promote high-quality guidelines and guide clinical practice in pediatrics.