An appraisal of published clinical guidelines in anesthesiology practice using the AGREE II instrument

• Published in: Canadian journal of anesthesia Vol. 68; no. 7; pp. 1038 - 1044
• Main Authors: Mai, Harry T., Croxford, Daniel, Kendall, Mark C., De Oliveira, Gildasio
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-07-2021; Springer Nature B.V
• Subjects: Anesthesia; Anesthesiology; Cardiology; Clinical medicine; Clinical practice guidelines; Consensus; Critical Care Medicine; Databases, Factual; Decision making; Editorials; Humans; Impact factors; Intensive; Libraries; Medicine; Medicine & Public Health; Pain; Pain Medicine; Patient Care; Pediatrics; Pneumology/Respiratory System; Practice Guidelines as Topic; Reports of Original Investigations; Research Design; Research methodology; Surgical techniques; Clinical guidelines; AGREE II instrument; Anesthesiology; Anesthesia practice; Perioperative medicine
• ISSN: 0832-610X; 1496-8975
• DOI: 10.1007/s12630-021-01973-9

Purpose
Clinical practice guidelines are developed to provide physicians with appraised scientific evidence and enhance their medical decision-making process. Poorly developed guidelines can have a negative impact on patient care, but the quality of clinical guidelines has not been evaluated in anesthesiology practice.
Methods
We evaluated the quality of clinical practice guidelines in anesthesiology retrieved from PubMed, Scopus, Cochrane Library, and Embase databases from August 2013 to August 2018 using a validated appraisal instrument. Exclusion criteria excluded consensus statements, editorials, non-clinical/legal-themed manuscripts, institutional protocols, research methods, and chronic pain and surgical technique guidelines.
Principal findings
A total of 96 clinical practice guidelines were included in the analysis. Seventy-one out of 96 (74%; 95% confidence interval, 65 to 83) guidelines had overall quality scores lower or equal to 5 and could not be recommended as published. Higher quality guidelines (overall score greater than 5) were published in journals with higher median [interquartile range] impact factors than lower quality guidelines (4.0 [3.5–6.5]
vs
3.8 [2.3–4.7];
P
= 0.02). The publication of a higher quality guideline was not associated with the year that the guideline was published or if the guideline was published by a society.
Conclusions
The overall quality of most guidelines relevant to the practice of anesthesiology were poor, and the domains applicability and rigor of development rated particularly low. Future groups developing clinical guidelines should consider using methodological support to improve the quality of guidelines relevant to the practice of anesthesiology.