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A systematic review of paediatric neurogenic lower urinary tract dysfunction guidelines using the Appraisal of
Priyank Yadav1,2, Abdulrahman Alsabban1,3, Thomas de Los Reyes1
1Division of Urology, The Hospital for Sick Children (SickKids), Toronto, ON, Canada.
Insights
This review found that clinical practice guidelines for paediatric neurogenic lower urinary tract dysfunction (NLUTD) offer high-quality recommendations. However, future updates should focus on improving guideline applicability and editorial independence for better clinical utility.
Area of Science:
- Urology
- Clinical Practice Guidelines
- Paediatric Healthcare
Background:
- Paediatric neurogenic lower urinary tract dysfunction (NLUTD) management requires clear, evidence-based clinical practice guidelines (CPGs).
- Assessing the quality and applicability of existing international CPGs is crucial for effective clinical implementation.
Approach:
- A systematic review of CPGs for paediatric NLUTD published between 2010 and 2022 was conducted.
- The Appraisal of Guidelines and Research Evaluation (AGREE) II instrument was used by six independent reviewers to assess guideline quality across six domains.
- Interrater reliability was evaluated using the intraclass correlation coefficient (ICC).
Key Points:
- Six CPGs were appraised, with the National Institute for Health and Care Excellence (NICE), Irish, and Spina Bifida Association (SBA) guidelines scoring highest overall.
- Guidelines demonstrated high scores in 'scope and purpose' and 'clarity of presentation' domains.
- Applicability and editorial independence domains received lower scores, indicating areas for improvement.
Conclusions:
- Current CPGs for paediatric NLUTD provide high-quality recommendations.
- The NICE, Irish, and SBA guidelines are identified as top-tier resources.
- Future guideline development should prioritize enhancing applicability and editorial independence to maximize clinical utility.
Objective:
To examine and critique current international clinical practice guidelines (CPGs) on management of paediatric neurogenic lower urinary tract dysfunction (NLUTD) and assess the applicability of these guidelines to clinical practice.
Materials And Methods:
We conducted a systematic review of all CPGs on NLUTD published in English from the year 2010 to 2022. Six reviewers independently used the Appraisal of Guidelines and Research Evaluation (AGREE) II instrument to appraise all eligible CPGs. This instrument is comprised of 23 items organised into six quality domains. The scores for each item and domain were tabulated for each reviewer and interrater reliability was assessed for each domain using the intraclass correlation coefficient (ICC).
Results:
Six CPGs were appraised and these included: National Institute for Health and Care Excellence (NICE), European Society for Paediatric Urology, International Children's Continence Society, Irish, Spina Bifida Association (SBA), and International Brazilian Journal of Urology guidelines. They had high mean standardised scores in the domain on 'scope and purpose' and 'clarity of presentation' but had low scores in the domain of 'applicability'. The top three CPGs based on overall score were the NICE, Irish and SBA guidelines and the reviewers had high degree of interrater reliability (ICC 0.912, P < 0.001). The mean scores in various domains for the top three guidelines were 95.8 (scope and purpose), 87.5 (stakeholder involvement), 69.1 (rigour of development), 94.0 (clarity of presentation), 68.4 (applicability), and 59.7 (editorial independence). The diagnostic and treatment recommendations of the top three guidelines were presented.
Conclusion:
The existing CPGs on paediatric NLUTD provide high-quality evidence based recommendations. The NICE, Irish and SBA guidelines were the top three CPGs identified. They scored high on most domains except applicability and editorial independence. These domains need to be considered for future updates to improve the utility.
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