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Methodology Adopted for the Development of Evidence-Based Guideline Recommendations on Childhood Empyema
Joseph L Mathew1,2,3,4,5
1Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India. dr.joseph.l.mathew@gmail.com.
Objective:
To describe the methodology adopted for the development of evidence-based guideline recommendations for pediatricians managing childhood empyema.
Methods:
The methodology followed contemporary methods for evidence-based guideline development. It included ten steps viz. (i) establishing a steering group (SG) and an evidence-based guideline development group (EBGDG), (ii) formal declarations of interest by EBGDG members, and scrutiny for conflicts by the SG, (iii) identifying and prioritizing questions in the PICOTS (Patient/population, Intervention/exposure, Comparison, Outcome, Time-frame, and Setting) format, (iv) building working teams to answer the questions, (v) searching for existing guidelines with potential for adaptation, adoption, or adolopment of recommendations, (vi) identifying existing systematic reviews addressing the prioritized questions, (vii) formal evidence synthesis (through systematic reviews) and critical appraisal of evidence for each question, (viii) drafting recommendation statements and formalizing them with strength and certainty of evidence, (ix) external peer review, and (x) preparation of the guideline document for dissemination.
Results:
The EBGDG collated 115 potential questions, narrowed them to 18 through the Delphi consensus-building process, and ultimately prioritized 11. The questions covered diverse aspects of empyema management including therapy options, microbiological and radiological investigations, and monitoring issues. There were no recent guidelines or systematic reviews addressing any of the 11 questions, thereby necessitating eleven de novo systematic reviews. The EBGDG examined the evidence from these reviews and certainty estimates, evaluated the criteria in the evidence-to-decision framework, and formulated evidence-based recommendation statements. The draft guideline underwent external peer review and finalization.
Conclusion:
The methodological rigor resulted in trustworthy recommendations for managing childhood empyema.
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