2019年期刊公开发表的中国临床实践指南文献调查与评价——引文分析

Investigation and Evaluation of Chinese Clinical Practice Guidelines Published in Medical Journals in 2019:Analysis of the Evidence

目的调查2019年期刊公开发表的中国临床实践指南推荐意见的证据引用现状,为合理利用研究证据支撑指南推荐意见提供参考。方法系统检索并筛选2019年期刊公开发表的中国临床实践指南,纳入有明确推荐意见、证据质量分级和相应分级说明的指南,提取指南推荐意见的引文信息并对其进行分析。结果共纳入指南31篇(中文29篇,英文2篇),包含568条推荐意见(平均每篇指南包含18条推荐意见)和3126篇引文,其中2541条引文作为证据在指南推荐意见说明中呈现(此类引文,下文简称"证据")。平均每篇指南引用82篇证据,平均每条推荐意见引用4篇证据。证据来源位居前3位的国家依次为中国(28.8%)、美国(25.9%)和英国(7.0%)。发表于近5年的证据仅占比39.2%(995/2541)。证据文献类型主要为随机对照试验(26.9%),系统评价仅占比12.0%。结论2019年期刊公开发表的中国指南,存在未明确列出推荐意见及对支撑推荐意见的证据引用不全面、实效性差等问题。指南制订者应合理利用当前可得的研究证据,进一步提高我国临床实践指南的制订质量。

Objective To investigate the current status of evidence of recommendations contained in Chinese clinical practice guidelines published in journals in 2019,so as to provide reference for the use of evidence for Chinese guidelines in the future.Methods We searched and analyzed information on Chinese guidelines published in 2019 with clear recommendations, grading of evidence quality and corresponding instructions of grading, as well as information on citations supporting the recommendations.Results A total of 31 guidelines(29 Chinese guidelines and 2 English guidelines) containing 568 recommendations and 3126 references were included. Each guideline included an average of 18 recommendations. Of these, 2541 references were presented as evidence in the statements of guideline recommendation(such references are referred to as “evidence” hereafter). The average number of evidence was 82 in each guideline and every recommendation has 4 pieces of evidence. The top three countries where the evidence was from were China(28.8%),the United States(25.9%),and the United Kingdom(7.0%). Only 39.2%(995/2541) of the evidence was published in the last 5 years. The most common type of evidence for guidelines was randomized controlled trials(26.9%). The citation of systematic reviews was only 12.0%.Conclusions Most of the Chinese guidelines published in 2019 did not have clear and unambiguous recommendations. Those guidelines with clear recommendations had incomplete and untimely evidence citations. Guideline developers should strengthen the rational use of currently available research evidence.