The quality of paediatric asthma guidelines: evidence underpinning diagnostic test recommendations from a meta-epidemiological study.

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Clinical Guidelines
Authored By
Thomas ET, Thomas ST, Perera R, Gill PJ, Moloney S, Heneghan CJ
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Interests
Pediatric Medicine
Immunology Allergy & Inflammation
Pulmonology
Speciality
Pediatric Medicine
Immunology Allergy & Inflammation
Pulmonology
Book Detail
volume
41
ISSN
1460-2229
No. of pages
10
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ISSN
1460-2229 ; Electronic
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true
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Additional Info
["Thomas ET, Thomas ST, Perera R, Gill PJ, Moloney S, Heneghan CJ","Publisher: Oxford University Press Country of Publication: England NLM ID: 8500875 Publication Model: Print Cited Medium: Internet ISSN: 1460-2229 (Electronic) Linking ISSN: 02632136 NLM ISO Abbreviation: Fam Pract Subsets: MEDLINE","Journal Article","2024-08-14","Family practice [Fam Pract] 2024 Aug 14; Vol. 41 (4), pp. 460-469.","English","1460-2229","Asthma*\/diagnosis , Practice Guidelines as Topic*, Humans ; Child ; Primary Health Care\/standards ; United Kingdom ; Child, Preschool ; Epidemiologic Studies ; Spirometry\/standards ; Evidence-Based Medicine","Humans, Child, Primary Health Care standards, United Kingdom, Child, Preschool, Epidemiologic Studies, Spirometry standards, Evidence-Based Medicine, Asthma diagnosis, Practice Guidelines as Topic","Family practice","41"]
Description
Background: Asthma is one of the most frequent reasons children visit a general practitioner (GP). The diagnosis of childhood asthma is challenging, and a variety of diagnostic tests for asthma exist. GPs may refer to clinical practice guidelines when deciding which tests, if any, are appropriate, but the quality of these guidelines is unknown.<br />Objectives: To determine (i) the methodological quality and reporting of paediatric guidelines for the diagnosis of childhood asthma in primary care, and (ii) the strength of evidence supporting diagnostic test recommendations.<br />Design: Meta-epidemiological study of English-language guidelines from the United Kingdom and other high-income countries with comparable primary care systems including diagnostic testing recommendations for childhood asthma in primary care. The AGREE-II tool was used to assess the quality and reporting of the guidelines. The quality of the evidence was assessed using GRADE.<br />Results: Eleven guidelines met the eligibility criteria. The methodology and reporting quality varied across the AGREE II domains (median score 4.5 out of 7, range 2-6). The quality of evidence supporting diagnostic recommendations was generally of very low quality. All guidelines recommended the use of spirometry and reversibility testing for children aged ≥5 years, however, the recommended spirometry thresholds for diagnosis differed across guidelines. There were disagreements in testing recommendations for 3 of the 7 included tests.<br />Conclusions: The variable quality of guidelines, lack of good quality evidence, and inconsistent recommendations for diagnostic tests may contribute to poor clinician adherence to guidelines and variation in testing for diagnosing childhood asthma.<br /> (© The Author(s) 2023. Published by Oxford University Press.)
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