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Intensive Care Medicine
Published in: Intensive Care Medicine 10/2010

01-10-2010 | Review

A critical appraisal of the quality of critical care pharmacotherapy clinical practice guidelines and their strength of recommendations

Authors: Sean K. Gorman, Michelle Ho Chung, Richard S. Slavik, Peter J. Zed, Kerry Wilbur, Vinay K. Dhingra

Published in: Intensive Care Medicine | Issue 10/2010

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Abstract

Objective

Clinical practice guideline (CPG) quality assessment is important before applying their recommendations. Determining whether recommendation strength is consistent with supporting quality of evidence is also essential. We aimed to determine quality of critical care pharmacotherapy CPGs and to assess whether high quality evidence supports strong pharmacotherapy recommendations.

Methods

MEDLINE (1966–February 2008), EMBASE (1980–February 2008), National Guideline Clearinghouse (February 2008) and personal files were searched to identify CPGs. Four appraisers evaluated each guideline using the appraisal of guidelines, research and evaluation (AGREE) instrument. AGREE assesses 23 items in six domains that include scope/purpose, stakeholder involvement, rigor of development, clarity, applicability and editorial independence. Standardized domain scores (0–100%) were determined to decide whether to recommend a guideline for use. One appraiser extracted strong pharmacotherapy recommendations and supporting evidence quality.

Results

Twenty-four CPGs were included. Standardized domain scores were clarity [69% (95% confidence interval (CI) 62–76%)], scope/purpose [62% (95% CI 55–68%)], rigor of development [51% (95% CI 42–60%)], editorial independence [39% (95% CI 26–52%)], stakeholder involvement [32% (95% CI 26–37%)] and applicability [19% (95% CI 12–26%)]. The proportion of guidelines that could be strongly recommended, recommended with alterations and not recommended was 25, 37.5 and 37.5%, respectively. High quality evidence supported 36% of strong pharmacotherapy recommendations.

Conclusion

Variation in AGREE domain scores explain why one-third of critical care pharmacotherapy CPGs cannot be recommended. Only one-third of strong pharmacotherapy recommendations were supported by high quality evidence. We recommend appraisal of guideline quality and the caliber of supporting evidence prior to applying recommendations.
Appendix
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Metadata
Title
A critical appraisal of the quality of critical care pharmacotherapy clinical practice guidelines and their strength of recommendations
Authors
Sean K. Gorman
Michelle Ho Chung
Richard S. Slavik
Peter J. Zed
Kerry Wilbur
Vinay K. Dhingra
Publication date
01-10-2010
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 10/2010
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-010-1786-8

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