Cough clinical practice guidelines: A critical review of scientific evidence and recommendations
EUROPEAN RESPIRATORY JOURNAL(2016)
摘要
OBJECTIVE: To systematically evaluate the quality of cough guidelines, and to delineate the distribution of the levels of evidence underlying the recommendations. METHODS: Systematic searches were conducted to identify cough guideline in MEDLINE. Four reviewers independently evaluated eligible guidelines using Appraisal of Guidelines for Research and Evaluation II. Agreement among reviewers was assessed by intra-class correlation coefficient. The number of recommendations, strength of recommendation, and levels of evidence were determined. RESULTS: Fourteen guidelines were identified. An overall high-degree agreement among reviewers was observed (ICC: 0.83; 95% CI: 0.80-0.85). The quality ranged from good to acceptable in scope and purpose 75% (range: 60-92%) and clarity and presentation domains 69% (54-90%), but not in stakeholder involvement 34% (18-64%), rigour of development 37% (9-82%), applicability 24% (10-80%) and editorial independence domains 25% (0-96%). Only one guideline was considered 9strongly recommended9 for clinical practice. More than 70% of recommendations were based on non-randomized studies (level C, 44.1%) and expert opinion (level D, 28.1%). The strength of recommendation mainly corresponded to grade II (57.3%). Compared with the 1 st version, all levels of evidence shifted proportionately towards level C evidence in the 2 nd version of ACCP guideline. CONCLUSIONS: The quality of cough CPGs is variable and recommendations are largely based on low-quality evidence. There is significant room for improvement to develop high-quality guidelines, which urgently warrants high-quality research lessen to vital gaps in the evidence for the formulation of cough guidelines.
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关键词
Cough,Chronic disease
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