小儿遗尿症指南和专家共识质量评价

Evaluation of the Guidelines and Consensuses on Enuresis in Children Using the AGREEⅡand RIGHT Checklists

背景小儿遗尿症是儿科常见病之一,有效的小儿遗尿症诊疗指南有助于症状的规范化控制和缓解,而制定高质量的临床实践指南是提高小儿遗尿症诊疗水平的重要方式。目的基于AGREEⅡ和RIGHT工具,评价2010年以来国内外发布的小儿遗尿症指南和专家共识的质量,以期为临床实践及后续指南的制订提供参考。方法检索中国知网、万方数据知识服务平台、维普网、中国生物医学文献数据库和PubMed(补充检索医脉通、世界卫生组织以及英国国家临床示范研究所等数据库)2010-01-01至2022-01-31公开发表的小儿遗尿症相关的诊疗指南和专家共识。采用AGREEⅡ和RIGHT工具评价纳入文献的方法学和报告质量。根据AGREEⅡ工具评价结果,将各指南/共识推荐等级评定为“推荐(A级)”“更新后推荐(B级)”和“不推荐(C级)”。使用组内相关系数(ICC)进行一致性评价。结果纳入8部指南和5部专家共识。共形成推荐意见185条,其中44条为诊断评估方面的意见,140条为治疗方面的推荐意见,1条为随访推荐意见。AGREEⅡ工具评价结果显示,范围和目的、参与人员、严谨性、清晰性、应用性和独立性6个领域的总得分(报告率)分别为(66.99%±16.73%)、(46.26%±21.56%)、(34.42%±26.73%)、(60.36%±32.13%)、(39.82%±20.14%)、(45.35%±37.93%),纳入的13篇文献中,无推荐等级为A的文献,推荐等级为B和C的文献分别为8篇和5篇。RIGHT工具评价结果显示,基本信息、背景、证据、推荐意见、评审和质量保证、资助与利益冲突声明和管理、其他方面7个领域的总得分(报告率)分别为(60.58%±12.19%)、(50.72%±20.18%)、(30.77%±26.88%)、(32.97%±27.53%)、25.00%(40.63%)、(25.96%±24.00%)、16.67%(33.33%)。AGREEⅡ工具评估结果中指南的范围和目的领域得分高于专家共识得分(P<0.05)。RIGHT工具评估中指南各领域得分与专家共识得分比较,差异均无统计学意义(P>0.05)。AGREEⅡ工具各领域一致性评价ICC均大于0.750,一致性较高;RIGHT工具各领域一致性评价ICC为0.736,一致性较好。结论本研究纳入的指南和专家共识总体方法学和报告质量均有待提高,纳入文献的推荐等级为B级和C级,缺少A级的文献,建议临床决策中优先参考高质量诊疗指南。目前尚无面向我国基层医师制定的小儿遗尿症诊疗指南,且现有的小儿遗尿症中医药管理指南证据质量有待提高,建议参照AGREEⅡ和RIGHT标准制定相关指南以指导小儿遗尿症的临床管理。

Background Enuresis in children is a common pediatric disease that can significantly reduce the quality of life of children and their families.High-quality guidelines on enuresis in children contribute to the standardization of control and improvement of clinical symptoms.So developing relevant high-quality clinical practice guidelines is a critical way to improve the diagnosis and treatment of enuresis in children.Objective To evaluate the quality of guidelines and expert consensuses on enuresis in children issued since 2010 using the AGREEⅡand RIGHT checklists,aiming at providing a reference for clinical practice and future development of relevant guidelines.Methods Guidelines and expert consensuses related to enuresis in children published from January 1,2010 to January 31,2022 were searched in databases of CNKI,Wanfang Data,VIP,CBM,and PubMed(with searching databases of MedLive,WHO and NICE as a supplement).The AGREEⅡand RIGHT checklists were used to evaluate the methodological and reporting quality of included studies.According to the AGREEⅡ,the recommended grade of each guideline/consensus was rated as"recommended(A)","recommended after update(B)",and"not recommended(C)".The intra-class correlation coefficient(ICC)was used for the consistency test.Results Altogether,eight guidelines and five consensuses were included,which provide 185 recommendations,including 44 for diagnosis and evaluation,140 for treatment,and one for follow-up.By the AGREEⅡchecklist,these 13 studies were assessed with average scores of(66.99%±16.73%),(46.26%±21.56%),(34.42%±26.73%),(60.36%±32.13%),(39.82%±20.14%)and(45.35%±37.93%)for scope and purpose,stakeholder involvement,rigour of development,clarity of presentation,applicability,and editorial independence,respectively.None of the studies were with recommendation grade A,eight were with recommendation grade B,and five were with grade C.The reporting rates of the studies in accordance with seven domains of basic information,background,evidence,recommendations,review and quality assurance,funding and declaration and management of interests and other information were(60.58%±12.19%),(50.72%±20.18%),(30.77%±26.88%),(32.97%±27.53%),25.00%(40.63%),(25.96%±24.00%)and 16.67%(33.33%),respectively.The guidelines had higher score in terms of the scope and purpose domain of AGREEⅡthan consensuses(P<0.05).The guidelines and consensuses had no significant differences in assessment results by each of the seven domains of RIGHT(P>0.05).The ICC for the reliability of each of the domains of the AGREEⅡchecklist in assessment was greater than 0.750,showing a high consistency.The ICC for the reliability of each of the domains of the RIGHT checklist was 0.736,which showed a good consistency.Conclusion The overall methodological and reporting quality of the included guidelines and consensuses needs to be improved.The recommended grades of the included literature consist of B and C without A,suggesting that high-quality guidelines should be referred first when making clinical decisions.Currently,there is no guideline for the diagnosis and treatment of enuresis in children in primary care in China,and the quality of existing guideline on Traditional Chinese Medicine management of enuresis in children needs to be improved.It is suggested to develop relevant guidelines according to the AGREEⅡand RIGHT checklists to guide the clinical management of enuresis in children.