基于AGREEⅡ的阑尾炎临床实践指南质量评价研究

Quality assessment on clinical practice guidelines in appendicitis：a study based on AGREE Ⅱ

摘要:

目的：了解全球阑尾炎临床实践指南现状，为规范开发和制订我国阑尾炎临床指南提供参考。方法：计算机检索MED－LINE、Embase、NGC（National Guideline Clearinghouse）、GIN（Guidelines International Network）、NICE（National Institute for Health and Clinical Excellence）和万方、中国知网及中国指南协作网等中英文数据库和相关网站（从建库至2014年12月31日）公开发表的国内外有关阑尾炎的临床指南，按照纳入、排除标准筛选指南。描述性分析纳入指南的名称、发表年份、发表机构、指南开发方法、参考文献数目等内容。按照国际公认的指南评价工具（appraisal of guidelines for research and evaluation，AGREE），评价分析纳入指南的方法学质量。结果：①共纳入7篇阑尾炎指南，发布时间跨度为2007至2014年，指南主题涉及筛查、诊断、药物治疗、手术治疗；纳入指南均为基于循证证据的指南。②纳入指南6个领域（范围和目的、制定指南的参与人员、制定的严谨性、清晰性与可读性、适用性、编撰的独立性）的平均得分分别为65.3%、38.63%、48.89%、78.3%、0%、14.29%。结论：基于循证证据的指南是当前临床实践指南制定的发展趋势，但不同国家和地区阑尾炎临床实践指南的整体质量不高，指南开发方法的严谨性和报告规范等有待提高。

Abstract:

Objective：To investigate and analyze the current situation of global appendicitis clinical practice guidelines and to provide references for the development and formulation of our native appendicitis clinical guidelines normatively. Methods：Chinese and Eng－lish databases were searched，including MEDLINE，Embase，National Guideline Clearinghouse，Guidelines International Network，Na－tional Institute for Health and Clinical Excellence，WANFANG database，CNKI and CPGN（Chinese practice guideline network），and relative websites（from established to December 31，2015）. Then literature was selected according to the inclusion and exclusion cri－teria. Names of guidelines，years of publication，institutions，guideline develop methods and number of each references were descrip－tively analyzed. The internationally recognized guideline evaluation tool，appraisal of guidelines for research and evaluation（AGREE） was applied to assess the methodogical quality of guidelines. Results：①A total of 7 appendicitis guidelines were included. Publica－tion dated from 2007 to 2014. The topics of these guidelines cover screening，diagnosis，drug therapy and surgical therapy；guidelines included are all evidence-based guidelines. ②The average scores of six domains（scope and purpose，stakeholders involvement，rigor of development，clarity of presentation，applicability and editorial independence） involved in the included guidelines were 65.3%，38.63%，48.89%，78.3%，0.0%，14.29%，respectively. Conclusion：There is a growing trend that clinical practice guidelines are devel－oped based on evidence. However，the total quality of reporting and the methodological rigor of guidelines need further improvement.