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Methodological quality of national guidelines for pediatric inpatient conditions
Gabrielle Hester1, Katherine Nelson, Sanjay Mahant
1Department of Pediatrics, University of Utah, Salt Lake City, Utah.
Insights
This study assessed national guidelines for pediatric inpatient conditions. Moderate to high-quality guidelines were found for conditions like asthma, informing quality improvement initiatives.
Area of Science:
- Pediatric hospital medicine
- Clinical guideline development
- Quality improvement in healthcare
Background:
- Standardizing care through guidelines is crucial for pediatric quality improvement (QI).
- A prioritized list of high-prevalence pediatric inpatient conditions was identified.
- The methodological quality of existing guidelines for these priority conditions was previously unknown.
Purpose of the Study:
- To evaluate the methodological quality of national clinical guidelines for 20 priority pediatric inpatient conditions.
- Assess the adherence of guidelines to established quality standards.
Main Methods:
- Systematic literature search of PubMed for national guidelines (2002-2012).
- Exclusion of single-focus or institutional guidelines.
- Methodological quality assessment using the Appraisal of Guidelines for Research and Evaluation (AGREE) tool, rated on a 7-point scale.
- Inter-rater reliability measured using weighted kappa coefficient.
Main Results:
- Seventeen guidelines met criteria for 13 conditions; 7 conditions lacked national guidelines.
- Highest quality guidelines: asthma (7), tonsillectomy (6.5), bronchiolitis (6.5).
- Lowest quality guidelines: sickle cell disease (mean 4), dental caries (mean 3.5).
- High inter-rater reliability (kappa = 0.83).
Conclusions:
- A set of moderate to high-quality national guidelines exists for priority pediatric inpatient conditions.
- These guidelines can be utilized by hospitals to enhance quality improvement efforts.
- Further development may be needed for conditions lacking high-quality guidelines.
Background:
Guidelines help inform standardization of care for quality improvement (QI). The Pediatric Research in Inpatient Settings network published a prioritization list of inpatient conditions with high prevalence, cost, and variation in resource utilization across children's hospitals. The methodological quality of guidelines for priority conditions is unknown.
Objective:
To rate the methodological quality of national guidelines for 20 priority pediatric inpatient conditions.
Design:
We searched sources including PubMed for national guidelines published from 2002 to 2012. Guidelines specific to 1 organism, test or treatment, or institution were excluded. Guidelines were rated by 2 raters using a validated tool (Appraisal of Guidelines for Research and Evaluation) with an overall rating on a 7-point scale (7 = the highest). Inter-rater reliability was measured with a weighted kappa coefficient.
Results:
Seventeen guidelines met inclusion criteria for 13 conditions; 7 conditions yielded no relevant national guidelines. The highest methodological-quality guidelines were for asthma, tonsillectomy, and bronchiolitis (mean overall rating 7, 6.5, and 6.5, respectively); the lowest were for sickle cell disease (2 guidelines) and dental caries (mean overall rating 4, 3.5, and 3, respectively). The overall weighted kappa was 0.83 (95% confidence interval 0.78-0.87).
Conclusions:
We identified a group of moderate to high methodological-quality national guidelines for priority pediatric inpatient conditions. Hospitals should consider these guidelines to inform QI initiatives.
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