首页|Analysis of COVID-19 Guideline Quality and Change of Recommendations:A Systematic Review

Analysis of COVID-19 Guideline Quality and Change of Recommendations:A Systematic Review

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Background.Hundreds of coronavirus disease 2019(COVID-19)clinical practice guidelines(CPGs)and expert consensus statements have been developed and published since the outbreak of the epidemic.However,these CPGs are of widely variable quality.So,this review is aimed at systematically evaluating the methodological and reporting qualities of COVID-19 CPGs,exploring factors that may influence their quality,and analyzing the change of recommendations in CPGs with evidence published.Methods.We searched five electronic databases and five websites from 1 January to 31 December 2020 to retrieve all COVID-19 CPGs.The assessment of the methodological and reporting qualities of CPGs was performed using the AGREE Ⅱinstrument and RIGHT checklist.Recommendations and evidence used to make recommendations in the CPGs regarding some treatments for COVID-19(remdesivir,glucocorticoids,hydroxychloroquine/chloroquine,interferon,and lopinavir-ritonavir)were also systematically assessed.And the statistical inference was performed to identify factors associated with the quality of CPGs.Results.We included a total of 92 COVID-19 CPGs developed by 19 countries.Overall,the RIGHT checklist reporting rate of COVID-19 CPGs was 33.0％,and the AGREE Ⅱ domain score was 30.4％.The overall methodological and reporting qualities of COVID-19 CPGs gradually improved during the year 2020.Factors associated with high methodological and reporting qualities included the evidence-based development process,management of conflicts of interest,and use of established rating systems to assess the quality of evidence and strength of recommendations.The recommendations of only seven(7.6％)CPGs were informed by a systematic review of evidence,and these seven CPGs have relatively high methodological and reporting qualities,in which six of them fully meet the Institute of Medicine(IOM)criteria of guidelines.Besides,a rapid advice CPG developed by the World Health Organization(WHO)of the seven CPGs got the highest overall scores in methodological(72.8％)and reporting qualities(83.8％).Many CPGs covered the same clinical questions(it refers to the clinical questions on the effectiveness of treatments of remdesivir,glucocorticoids,hydroxychloroquine/chloroquine,interferon,and lopinavir-ritonavir in COVID-19 patients)and were published by different countries or organizations.Although randomized controlled trials and systematic reviews on the effectiveness of treatments of remdesivir,glucocorticoids,hydroxychloroquine/chloroquine,interferon,and lopinavir-ritonavir for patients with COVID-19 have been published,the recommendations on those treatments still varied greatly across COVID-19 CPGs published in different countries or regions,which may suggest that the CPGs do not make sufficient use of the latest evidence.Conclusions.Both the methodological and reporting qualities of COVID-19 CPGs increased over time,but there is still room for further improvement.The lack of effective use of available evidence and management of conflicts of interest were the main reasons for the low quality of the CPGs.The use of formal rating systems for the quality of evidence and strength of recommendations may help to improve the quality of CPGs in the context of the COVID-19 pandemic.During the pandemic,we suggest developing a living guideline of which recommendations are supported by a systematic review for it can facilitate the timely translation of the latest research findings to clinical practice.We also suggest that CPG developers should register the guidelines in a registration platform at the beginning for it can reduce duplication development of guidelines on the same clinical question,increase the transparency of the development process,and promote cooperation among guideline developers all over the world.Since the International Practice Guideline Registry Platform has been created,developers could register guidelines prospectively and internationally on this platform.

Siya Zhao、Shuya Lu、Shouyuan Wu、Zijun Wang、Qiangqiang Guo、Qianling Shi、Hairong Zhang、Juanjuan Zhang、Hui Liu、Yunlan Liu、Xianzhuo Zhang、Ling Wang、Mengjuan Ren、Ping Wang、Hui Lan、Qi Zhou、Yajia Sun、Jin Cao、Qinyuan Li、Janne Estill、Joseph L.Mathew、Hyeong Sik Ahn、Myeong Soo Lee、Xiaohui Wang、Chenyan Zhou、Yaolong Chen

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School of Public Health,Lanzhou University,Lanzhou,China

Institute of Health Data Science,Lanzhou University,Lanzhou,China

Department of Pediatric,Sichuan Provincial People's Hospital,University of Electronic Science and Technology of China,Chengdu,China

Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital,Chengdu,China

Evidence-Based Medicine Center,School of Basic Medical Sciences,Lanzhou University,Lanzhou,China

The First School of Clinical Medicine,Lanzhou University,Lanzhou,China

National Clinical Research Center for Child Health and Disorders,Ministry of Education Key Laboratory of Child Development and Disorders,China International Science and Technology Cooperation Base of Child Development and Critical Disorders,Children's Hospital of Chongqing Medical University,Chongqing,China

Institute of Global Health,University of Geneva,Geneva,Switzerland

Institute of Mathematical Statistics and Actuarial Science,University of Bern,Bern,Switzerland

Advanced Pediatrics Centre,PGIMER Chandigarh,Chandigarh,India

Department of Preventive Medicine,Korea University,Seoul,Republic of Korea

Korea Cochrane Centre,Seoul,Republic of Korea

Evidence Based Medicine,Seoul,Republic of Korea

Korea University School of Medicine,Seoul,Republic of Korea

Korea Institute of Oriental Medicine,Daejeon,Republic of Korea

University of Science and Technology,Daejeon,Republic of Korea

London Southbank University,London,UK

Tianjin University of Traditional Chinese Medicine,Tianjin,China

WHO Collaborating Centre for Guideline Implementation and Knowledge Translation,Lanzhou,China

Guideline International Network Asia,China

Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province,Lanzhou University,Lanzhou,China

Lanzhou University GRADE Center,China

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2022

ISSN：
年,卷(期)：2022.(2)
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