重症成人营养：临床实践指南的系统性质量评定
2016年3月17日，欧洲肠外肠内营养学会（ESPEN）官方期刊《临床营养》（Clin Nutr）在线发表了西班牙伊比利亚美洲循证中心、智利安托法加斯塔大学、智利安托法加斯塔地区医院、西班牙圣保罗生物医学研究所、西班牙生物医学研究网络中心流行病学与公共卫生研究所、西班牙巴塞罗那自治大学、加拿大麦克马斯特大学关于重症成人营养临床实践指南的系统性质量评定。
Clin Nutr. 2016 Mar 17.[Epub ahead of print]
Nutrition in critically ill adults: A systematic quality assessment of clinical practice guidelines.
Fuentes Padilla P, Martínez G, Vernooij RW, Cosp XB, Alonso-Coello P.
Iberoamerican Cochrane Centre, Barcelona, Spain.
Universidad de Antofagasta, Antofagasta, Chile.
Hospital Regional de Antofagasta, Antofagasta, Chile.
Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.
CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
Universitat Autònoma de Barcelona, Barcelona, Spain.
McMaster University, Hamilton, ON, Canada.
BACKGROUND & AIMS: Nutritional support in the acutely ill is a complex topic. Clinical practice guidelines (CPGs) have been developed to assist healthcare professionals working in this field. However, the quality of these clinical guidelines has not yet been systematically assessed. The objective of our study was to identify and assess the quality of CPGs on nutrition in critically ill adult patients.
METHODS: We performed a systematic search to identify CPGs on nutrition in critically ill adult patients. Three independent appraisers assessed six domains (scope and purpose, stakeholder involvement, rigour of development, clarity of presentation, applicability and editorial independence) of the eligible CPGs using the Appraisal of Guidelines, Research, and Evaluation II (AGREE II) instrument.
RESULTS: Nine CPGs were selected. Overall agreement among appraisers was very good (ICC: 0.853; 95% CI: 0.820-0.881). The mean scores for each AGREE domain were the following: "scope and purpose" 76.2% ± 13.7%; "stakeholder involvement" 42.8% ± 16.5%; "rigour of development" 57.9% ± 18.1%; "clarity of presentation" 76.9% ± 13.7%; "applicability" 30.1% ± 22.8%; and 42.1% ± 23.9% for "editorial independence". Four CPGs were deemed "Recommended"; three "Recommended with modifications"; and two "Not recommended". We did not observe improvement over time in the overall quality of the CPGs.
CONCLUSIONS: The overall quality of CPGs on nutrition in critically ill adults is suboptimal, with only four CPGs being recommended for clinical use. Our results highlight the need to revise and improve CPG development processes in this field.
KEYWORDS: AGREE instrument; Clinical practice guidelines; Critically ill; Guidelines; Nutrition therapy; Quality assessment
PMID: 27068586
PII: S0261-5614(16)00096-0
DOI: 10.1016/j.clnu.2016.03.005
