Critical evaluation of scientific content in pediatric respiratory guidelines in china

Background and Aim: The pediatric guidelines for respiratory diseases in China have been rapidly proliferated under increasing pressures to provide high quality healthcare with the best possible evidence, but little is known about their quality and validity. The purpose of this study is to critically assess the development process and scientific content of pediatric guidelines for respiratory diseases in China. Methods: We systematic searched four Chinese databases (CBM, WANFANG, VIP and CNKI) to identify pediatric guidelines for respiratory diseases published in a peer-reviewed journal. Four reviewers independently appraised eligible guidelines with Appraisal of Guidelines for Research and Evaluation II (AGREE II), and the overall agreement among reviewers was assessed by intra-class correlation coefficient (ICC). Each eligible guideline was to determine recommendations given and scientific evidence used. Results: A total of 30 Chinese pediatric guidelines were identified which published in 11 medical journals from 2000 to 2016. Of these, 21 (70.0%) guidelines were developed by medical societies or government, and 9 (30.0%) guidelines were focused on Traditional Chinese Medicine (TCM). The majority (23,76.7%) were focused on both diagnosis and treatment. Only 6 (20.0%) guidelines claimed themselves as evidence-based guidelines and 13 (43.3%) as Expert consensus. The scores of the six AGREE domains were low: 45.8% for scope and purpose (range: 18.1 to 73.6%), 16.1% for stakeholder involvement (range: 1.4 to 38.9%), 5.4% for rigor of development (range: 1.0 to 27.1%), 59.1% for clarity and presentation (range: 37.5 to 76.4%), 11.1% for applicability (range: 1.0 to 28.1%), and 4.2% for editorial independence (range: 0 to 64.6%). Only one guidelines (3.3%) were recommended for clinical practice with modifications. Conclusion: The overall quality of pediatric guidelines for respiratory diseases in China was poor. More effort needs to be paid to improve the quality of guidelines especially in rigorous methodology and transparency of development. Further, there are still areas in pediatric respiratory diseases that need more high-quality research.