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Quality and consistency of clinical practice guidelines for treating children with COVID-19

Qinyuan Li1, Qi Zhou2,3, Yangqin Xun3

  • 1Department of Respiratory Medicine Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China.

Annals of Translational Medicine
|May 14, 2021
PubMed

Insights

Clinical practice guidelines for pediatric Coronavirus Disease 2019 (COVID-19) treatment show low quality and inconsistent recommendations. Limited evidence from children hinders effective care guidance.

Area of Science:

  • Pediatric Infectious Diseases
  • Clinical Practice Guidelines
  • Evidence-Based Medicine

Background:

  • The Coronavirus Disease 2019 (COVID-19) pandemic significantly impacts children's health.
  • Numerous clinical practice guidelines (CPGs) exist for pediatric COVID-19 treatment.
  • The quality and consistency of these CPGs are largely unknown.

Purpose of the Study:

  • To systematically review and evaluate the quality of existing CPGs for managing COVID-19 in children.
  • To assess the methodological rigor and reporting completeness of pediatric COVID-19 CPGs.
  • To analyze the consistency of treatment recommendations across guidelines.

Main Methods:

  • Systematic literature search of databases (Medline, Embase) and guideline repositories.
  • Evaluation of guideline quality using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool.
  • Assessment of reporting completeness using the Reporting Items for practice Guidelines in HealThcare (RIGHT) checklist.
  • Analysis of recommendation consistency and supporting evidence.

Main Results:

  • Twenty pediatric COVID-19 CPGs were included.
  • Methodological quality was predominantly low (95%), with only one moderate.
  • Reporting quality was mostly moderate (60%), with one high-quality guideline.
  • Significant inconsistencies were found in recommendations for treatments like remdesivir, interferon, glucocorticoids, and IVIG.
  • None of the guidelines cited clinical trials involving pediatric COVID-19 patients.

Conclusions:

  • Pediatric COVID-19 CPGs exhibit suboptimal methodological and reporting quality.
  • Treatment recommendations vary widely among guidelines, indicating a lack of consensus.
  • The evidence base derived from pediatric COVID-19 studies used in these guidelines is notably limited.
Abstract

Keywords:
Clinical practice guidelines (CPGs)Coronavirus Disease 2019 (COVID-19)childrenconsistency analysisquality appraisal

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