Coronavirus (1279) Quality and consistency of clinical practice guidelines for treating children with COVID-19

17 May, 2021

Dear HIFA and CHIFA colleagues,

This open access paper looks at the quality of clinical practice guidelines for treating children with COVID-19. Citation, abstract and a comment from me below.

CITATION: Qinyuan Li et al. Quality and consistency of clinical practice guidelines for treating children with COVID-19

Annals of Translational Medicine, Vol 9, No 8 (April 2021)

Correspondence to: Zhengxiu Luo chenyaolong@lzu.edu.cn

ABSTRACT:

Background: The Coronavirus Disease 2019 (COVID-19) pandemic negatively affects children’s health. Many guidelines have been developed for treating children with COVID-19. The quality of the existing guidelines and the consistency of recommendations remains unknown. Therefore, we aim to review the clinical practice guidelines (CPGs) for children with COVID-19 systematically.

Methods: We systematically searched Medline, Embase, guideline-related websites, and Google. The Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool and Reporting Items for practice Guidelines in HealThcare (RIGHT) checklist were used to evaluate the methodological and reporting quality of the included guidelines, respectively. The consistency of recommendations across the guidelines and their supporting evidence were analyzed.

Results: Twenty guidelines were included in this study. The mean AGREE II score and mean RIGHT reporting rate of the included guidelines were 37% (range, 22–62%) and 52% (range, 31–89%), respectively. As for methodological quality, no guideline was classified as high, one guideline (5%) moderate, and 19 (95%) low. In terms of reporting quality, one guideline (5%) was rated as high, 12 guidelines (60%) moderate, and seven (35%) low. Among included guidelines, recommendations varied greatly in the use of remdesivir (recommend: 25%, not recommend: 45%, not report: 30%), interferon (recommend: 15%, not recommend: 50%, not report: 35%), glucocorticoids (recommend: 50%, not recommend: 20%, not report: 30%), and intravenous immune globulin (recommend: 35%, not recommend: 30%, not report: 35%). None of the guidelines cited clinical trials from children with COVID-19.

Conclusions: The methodological and reporting quality of guidelines for treating children with COVID-19 was not high. Recommendations were inconsistent across different guidelines. The supporting evidence from children with COVID-19 was very limited.

COMMENT (NPW): The authors do not appear to analyse the reasons for inconsistency. As a new disease emerges, there is inevitably a great deal of clinical uncertainty. That said, the inconsistencies among guidelines are huge, and raise the question of whether more could be done to harmonise guideline development processes, even in the early phases. The authors note that their review embraces up until September 2020. It will be interesting to see how consistency has evolved since then.

We would be interested to hear from any members who have used guidelines for the care of children with COVID-19. What has been your experience?

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Neil Pakenham-Walsh, HIFA Coordinator, neil@hifa.org www.hifa.org