A critical appraisal of the quality of critical care pharmacotherapy clinical practice guidelines and their strength of recommendations

Department of Pharmacy, Capital District Health Authority, College of Pharmacy, Dalhousie University, c/o Rm 2043 Victoria Building, 1276 South Park Street, Halifax, NS, B3H 2Y9, Canada.
Intensive Care Medicine (Impact Factor: 7.21). 03/2010; 36(10):1636-43. DOI: 10.1007/s00134-010-1786-8
Source: PubMed


Clinical practice guideline (CPG) quality assessment is important before applying their recommendations. Determining whether recommendation strength is consistent with supporting quality of evidence is also essential. We aimed to determine quality of critical care pharmacotherapy CPGs and to assess whether high quality evidence supports strong pharmacotherapy recommendations.
MEDLINE (1966-February 2008), EMBASE (1980-February 2008), National Guideline Clearinghouse (February 2008) and personal files were searched to identify CPGs. Four appraisers evaluated each guideline using the appraisal of guidelines, research and evaluation (AGREE) instrument. AGREE assesses 23 items in six domains that include scope/purpose, stakeholder involvement, rigor of development, clarity, applicability and editorial independence. Standardized domain scores (0-100%) were determined to decide whether to recommend a guideline for use. One appraiser extracted strong pharmacotherapy recommendations and supporting evidence quality.
Twenty-four CPGs were included. Standardized domain scores were clarity [69% (95% confidence interval (CI) 62-76%)], scope/purpose [62% (95% CI 55-68%)], rigor of development [51% (95% CI 42-60%)], editorial independence [39% (95% CI 26-52%)], stakeholder involvement [32% (95% CI 26-37%)] and applicability [19% (95% CI 12-26%)]. The proportion of guidelines that could be strongly recommended, recommended with alterations and not recommended was 25, 37.5 and 37.5%, respectively. High quality evidence supported 36% of strong pharmacotherapy recommendations.
Variation in AGREE domain scores explain why one-third of critical care pharmacotherapy CPGs cannot be recommended. Only one-third of strong pharmacotherapy recommendations were supported by high quality evidence. We recommend appraisal of guideline quality and the caliber of supporting evidence prior to applying recommendations.

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    • "In this study, we found that the quality of EB guideline in TCM for RA management was higher than that of CB–EB and CB guideline, as well as the recommendations from the EB were more recommended by the CPGs than those from the CB–EB and CB guidelines. Like CPG development in biomedicine, EB guideline development in TCM should be the right direction [21] [22] [23] [24], and more and more clinical evidence would give much help in the future CPG development in TCM. EB guideline is the mainstream and trend of guideline development, because guidelines based on a consensus of expert opinion or on unsystematic literature survey have been criticized as not reflecting current medical knowledge and being liable to bias [25] [26], and EB guidelines have better quality than CB and CB–EB guidelines [14]. "
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