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A SYSTEMATIC APPRAISAL OF THE QUALITY OF CLINICAL GUIDELINES FOR ACUTE PANCREATITIS
Author(s) -
Srinivasa S.,
Vather R.,
Loveday B.,
Phillips A.,
Windsor J. A.
Publication year - 2009
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/j.1445-2197.2009.04920_16.x
Subject(s) - medicine , guideline , cinahl , grading (engineering) , medline , specialty , quality of evidence , family medicine , pancreatitis , meta analysis , psychological intervention , nursing , pathology , civil engineering , political science , law , engineering
Purpose: Patient management decisions are increasingly based on clinical guidelines, and guideline quality influences patient outcome. Many guidelines for the management of acute pancreatitis exist, but their quality has not been formally evaluated. This study aimed to appraise the quality of acute pancreatitis guidelines. Methodology: A literature search identified relevant guidelines using MEDLINE, EMBASE, CINAHL and National Guidelines Clearinghouse. Two reviewers independently appraised guideline quality using three validated instruments: Grilli, Shaneyfelt and AGREE, with maximum scores of 4, 25, and 92 respectively. Results: Thirty‐one guidelines from 1988–2008 were analysed, of which 22/31 (71%) were endorsed by official bodies and 9/31 (29%) did not have official endorsement. Twelve specialties were included in guideline development, and 21/31 (67%) guidelines involved multiple specialties. Only 8 (26%) guidelines included evidence grading. The median (range) quality scores were: Grilli, 2 (0–4); Shaneyfelt, 13 (5–23); AGREE, 59 (37–82). There was good correlation between instruments (r = 0.85–0.96, p < 0.001). Guideline quality did not increase with the year of publication (r2 = 0.05, p = 0.3). Guidelines endorsed by official bodies scored more highly than those without endorsement (AGREE 62.5 vs. 45.0, p < 0.001), while those developed by multiple specialties did not score more highly than those developed by a single specialty (AGREE 59.0 vs. 50.0, p = 0.36). Conclusion: Current acute pancreatitis guidelines range widely in quality, and have not improved over time. Their quality is higher if endorsed by official bodies. While higher quality guidelines do not ensure better patient outcome, there is room for improvement.