Quality of critical care clinical practice guidelines: Assessment with AGREE II instrument

Study objective: Clinical practice guidelines (CPGs) are cornerstones for the management of critically ill patients. Numerous CPGs have been generated in critical care medicine, but their qualities have never been systematically appraised. The aim of the present study was to systematically assess the quality of critical care CPGs. Design: A systematic electronic search was performed in PubMed and Scopus. All critical care CPGs were included for analysis. Setting: Not applicable. Patients: Not applicable. Intervention: None. Measurements: The Appraisal of guidelines for research & evaluation II (AGREE II) instrument was employed to appraise the quality. CPGs were assessed independently by three raters and intraclass correlation coefficient to represent the agreement among raters. Main results: A total of 89 CPGs were included for quantitative analysis. The results showed that domaffil (scope and purpose) had the highest scores (0.93, IQR: 0.89-0.98) and domain 2 (stakeholder involvement) had the lowest scores (0.37, IQR: 0.30-0.46). The overall score was 0.83 (IQR: 0.67-0.83). Publication year was not associated with scaled scores in each domain. Domain 2 (stakeholder involvement) was significantly associated with the number of societies (coefficient: 0.702, p = 0.033). Also, greater number of societies were associated with higher scaled scores of domain 3 (coefficient: 0.768, p = 0.027), 4 (coefficient: 0.730, p = 0.029) and 5 (coefficient: 0.995, p = 0.023). Conclusions: The study showed that the reporting quality of critical care CPGs were suboptimal. The reporting quality varied across the six domains, with the highest quality in domain 1 and lowest quality in domain 2. Strenuous efforts need to be made to improve the reporting of critical care CPGs.