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Review
. 2022 Nov 25:21:e20220032.
doi: 10.1590/1677-5449.202200321. eCollection 2022.

The quality of guidelines for treatment of carotid artery disease: a critical appraisal using the AGREE II instrument

Affiliations
Review

The quality of guidelines for treatment of carotid artery disease: a critical appraisal using the AGREE II instrument

Stefany Gimenes Baptista Coutinho et al. J Vasc Bras. .

Abstract

Clinical Practice Guidelines (CPG) are structured recommendations based on systematic reviews of the available evidence and are useful tools to support clinical decision-making. However, studies have raised concerns about the methodological and scientific quality of several CPG, which can affect their application in clinical practice. The objective of this study was to perform a systematic appraisal of the methodological quality of carotid atherosclerotic disease clinical guidelines, published from 2000 to 2019, using the AGREE II instrument (Appraisal of Guidelines for Research and Evaluation Instrument II). The appraisers independently assessed the quality of the CPG included in the study for each of the 6 domains of the AGREE II tool. The CPG were rated as high, moderate, or low quality using a points scale. A total of 9 CPGs were selected for appraisal. Except for domain 2 (kappa=0.715), excellent agreement was observed between the appraisers (kappa>0.75). Five of the CPGs were rated as high overall methodological quality rating, 5 were rated as moderate overall methodological quality, and 2 were rated low overall methodological quality. The authors conclude that: (1) appraisal of carotid atherosclerotic disease clinical guidelines using the AGREE II instrument is feasible, with a high degree of agreement among appraisers; and (2) that most CPGs on the management of atherosclerotic carotid disease have high methodological quality.

Resumo: Diretrizes clínicas (DCs) são recomendações estruturadas baseadas na revisão sistemática da evidência disponível, sendo ferramentas úteis na tomada de decisões clínicas. Entretanto, estudos têm levantado preocupação quanto à qualidade metodológica e científica de várias DCs, que podem afetar sua aplicação na prática clínica. O objetivo do presente estudo foi fazer uma avaliação sistemática da qualidade metodológica das DCs que abordam o tratamento da doença arterial obstrutiva carotídea, publicadas entre 2000 e 2019, utilizando a ferramenta AGREE II (Appraisal of Guidelines Research and Evaluation Instrument II). Os pesquisadores avaliaram independentemente a qualidade das DCs incluídas no estudo em cada um dos seis domínios da ferramenta AGREE II. Por meio de um sistema de pontuação, as DCs foram classificadas em alta, moderada e baixa qualidade. Um total de nove DCs foram selecionadas. Exceto pelo domínio dois (Kappa = 0,715), houve concordância excelente entre os três avaliadores (Kappa > 0,75). Considerando-se a avaliação global da qualidade metodológica das DCs, cinco foram consideradas de alta qualidade (55%), duas foram consideradas de qualidade moderada e duas foram consideradas de baixa qualidade. Concluímos que (1) foi factível a utilização da AGREE II para a avaliação de DCs sobre o tratamento da doença arterial obstrutiva carotídea com alto grau de concordância inter-avaliadores; e que (2) a maioria das DCs disponíveis sobre o tratamento da doença arterial obstrutiva carotídea tem alta qualidade metodológica.

Keywords: atherosclerosis; carotid artery diseases; carotid stenosis; practice guideline.

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Conflict of interest statement

Conflicts of interest: No conflicts of interest declared concerning the publication of this article.

Figures

Figure 1
Figure 1. Metric used for methodological quality rating of each guideline (extracted from Molino et al.16). AGREE II: Appraisal of Guidelines for Research and Evaluation Instrument II.
Figura 1
Figura 1. Métrica utilizada para avaliação da qualidade metodológica global de cada diretriz clínica (extraída de Molino et al.16). AGREE II: Appraisal of Guidelines Research and Evaluation Instrument II.

References

    1. Field MJ, Lohr KN. Clinical practice guidelines: directions for a new program. Washington: National Academies Press; 1990. [citado 2022 maio 10]. https://nap.nationalacademies.org/catalog/1626/clinical-practice-guideli... . - PubMed
    1. Graham R, Mancher M, Wolman DM, Greenfield S, Steinberg E. Clinical practice guidelines we can trust. Washington: National Academies Press; 2011. - DOI - PubMed
    1. Woolf SH, Grol R, Hutchinson A, Eccles M, Grimshaw J. Clinical guidelines: potential benefits, limitations, and harms of clinical guidelines. BMJ. 1999;318(7182):527–530. doi: 10.1136/bmj.318.7182.527. - DOI - PMC - PubMed
    1. Grol R. Successes and failures in the implementation of evidence-based guidelines for clinical practice. Med Care. 2001;39(8):II46–54. doi: 10.1097/00005650-200108002-00003. - DOI - PubMed
    1. Reis ECD, Passos SRL, Santos MABD. Quality assessment of clinical guidelines for the treatment of obesity in adults: application of the AGREE II instrument. Cad Saúde Pública. 2018;34(6):e00050517. doi: 10.1590/0102-311x00050517. - DOI - PubMed

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