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The quality of paediatric asthma guidelines: evidence underpinning diagnostic test recommendations from a
Elizabeth T Thomas1, Sarah T Thomas2, Rafael Perera3
1Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Insights
The quality of childhood asthma diagnostic guidelines for primary care is variable and often lacks strong evidence. Inconsistent recommendations may lead to varied testing practices in diagnosing pediatric asthma.
Area of Science:
- Pediatric Pulmonology
- Clinical Practice Guidelines
- Evidence-Based Medicine
Background:
- Childhood asthma diagnosis is a frequent reason for primary care visits.
- Accurate diagnosis is challenging, with various tests available.
- The quality of clinical practice guidelines for asthma diagnosis is largely unknown.
Purpose of the Study:
- To assess the methodological quality and reporting of pediatric asthma diagnostic guidelines.
- To evaluate the strength of evidence supporting diagnostic test recommendations in primary care.
Main Methods:
- Meta-epidemiological study of 11 English-language guidelines from high-income countries.
- Utilized the AGREE-II tool for guideline quality assessment.
- Employed GRADE methodology to assess the quality of evidence for diagnostic tests.
Main Results:
- Guideline quality and reporting varied significantly (AGREE-II median score 4.5/7).
- Evidence supporting diagnostic recommendations was generally of very low quality.
- Inconsistent recommendations were found for spirometry thresholds and other diagnostic tests.
Conclusions:
- Variable guideline quality and weak evidence may impact clinician adherence.
- Inconsistent diagnostic test recommendations contribute to variations in childhood asthma diagnosis.
- Further research is needed to improve the quality of asthma diagnostic guidelines.
Background:
Asthma is one of the most frequent reasons children visit a general practitioner (GP). The diagnosis of childhood asthma is challenging, and a variety of diagnostic tests for asthma exist. GPs may refer to clinical practice guidelines when deciding which tests, if any, are appropriate, but the quality of these guidelines is unknown.
Objectives:
To determine (i) the methodological quality and reporting of paediatric guidelines for the diagnosis of childhood asthma in primary care, and (ii) the strength of evidence supporting diagnostic test recommendations.
Design:
Meta-epidemiological study of English-language guidelines from the United Kingdom and other high-income countries with comparable primary care systems including diagnostic testing recommendations for childhood asthma in primary care. The AGREE-II tool was used to assess the quality and reporting of the guidelines. The quality of the evidence was assessed using GRADE.
Results:
Eleven guidelines met the eligibility criteria. The methodology and reporting quality varied across the AGREE II domains (median score 4.5 out of 7, range 2-6). The quality of evidence supporting diagnostic recommendations was generally of very low quality. All guidelines recommended the use of spirometry and reversibility testing for children aged ≥5 years, however, the recommended spirometry thresholds for diagnosis differed across guidelines. There were disagreements in testing recommendations for 3 of the 7 included tests.
Conclusions:
The variable quality of guidelines, lack of good quality evidence, and inconsistent recommendations for diagnostic tests may contribute to poor clinician adherence to guidelines and variation in testing for diagnosing childhood asthma.
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