Clinical Practice Guidelines and Recommendations in the Context of the COVID-19 Pandemic: Systematic Review and Critical Appraisal

Background: The number of published clinical practice guidelines and recommendations related to SARS-CoV-2 infections causing COVID-19 has rapidly increased to address the need to deliver healthcare safely in the current pandemic. The aim of our study was to explore if basic methodological standards of guideline development have been met. Methods: We conducted a rapid systematic review of guidelines published until April 27th, 2020 supervised by an international expert task force including representatives from each of the six WHO regions. At least two reviewers independently extracted guideline characteristics, conducted critical appraisal according to the Appraisal of Guidelines for Research and Evaluation Instrument (AGREE II) and classified the guidelines using the Association of the Scientific Medical Societies (AWMF) Guidance Manual and Rules for Guideline Development. Findings: There were 1342 titles screened and 188 guidelines included. The most frequent medical areas addressed were acute COVID-19 care (n=45; 24%), surgery (n=41; 22%), oncology (n=20; 11%), radiology (n=13; 7%) and cardiology (n=10; 6%). Patients were included in development of only one guideline. A process for regular updates was described in 27 guidelines (14%). The highest average AGREE II domain score was 89% for scope and purpose, the lowest for rigor of development (25%). Eight guidelines were based on a systematic literature search and structured consensus process by representative experts (classified as the highest methodological quality, S3 according to AWMF). Conclusion: Despite clear scope, most publications fell short of basic methodological standards of guideline development. Guidelines should include up-to-date information, transparent stakeholder involvement and rigorous methodologies. Funding Statement: This study was partly funded by the COVID19-Rapid Response Funding Scheme of the Wiener Wissenschafts-, Forschungs- und Technologiefonds (WWTF)/Vienna Science and Technology Fund (project number COV20-028). The funding institution had no influence on the results of this work. Declaration of Interests: The authors declare no competing interests related to this work.