A novel method of rapid appraisal of clinical practice guidelines for children with enuresis

Summary Background Enuresis (bedwetting) is a common but variably managed pediatric condition. Despite an abundance of published documents which provide recommendations for clinical evaluation and management of enuresis, no formal appraisal of their methodological quality has been undertaken. Objective The objective of the study is to evaluate the quality of current pediatric guidelines for enuresis (bedwetting) using a novel method of appraisal. Study design A comprehensive gray literature search was undertaken to identify guideline documents that provided recommendations for management of enuresis in children and adolescents. The search strategy included guideline databases, targeted websites, Google search engines, and MEDLINE. Guideline documents included clinical practice guidelines, consensus documents, position statements, and other clinical review documents. Each document underwent basic appraisal by two independent assessors using the International Centre for Allied Health Evidence (iCAHE) Guideline Quality Checklist. Those documents which (1) had an iCAHE quality score of ≥10; (2) used a systematic search strategy; and (3) linked evidence to their recommendations underwent further detailed appraisal using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. Results Eighteen documents were shortlisted for basic appraisal. The iCAHE highlighted a lack of information regarding underlying evidence and dates (mean score 36% and 41%, respectively). Only three documents met basic quality criteria and progressed to detailed appraisal using the AGREE II. These included guidelines produced by the Paediatric Society of New Zealand and National Clinical Guideline Centre and a position statement from the Canadian Paediatric Society. All three guidelines presented clear and unambiguous recommendations (mean score 80%). However, information regarding stakeholder involvement was lacking (mean score 50%). Conclusions Several guidelines exist for the evaluation and management of children with enuresis, but many lack appropriate methodological quality standards. The guideline produced by the National Clinical Guideline Centre achieved the highest quality rating and is recommended for future adaptation and implementation in relevant clinical settings. Table AGREE II standardized domain scores AGREE II instrument Guideline PSNZ NCGC CPS Domain 1 Scope and purpose 67% 100% 39% 2 Stakeholder involvement 44% 89% 17% 3 Rigor of development 67% 98% 58% 4 Clarity of presentation 72% 89% 78% 5 Applicability 67% 88% 42% 6 Editorial independence 92% 75% 33% Overall recommendation rating a Strongly recommended Strongly recommended Recommended with alteration AGREE II, Appraisal of Guidelines for Research and Evaluation II instrument; PSNZ, Paediatric Society of New Zealand; NCGC, National Clinical Guideline Centre; CPS, Canadian Paediatric Society. a Overall recommendation rating was determined according to the following criteria: strongly recommended = ≥4 domains rated above 60%; recommended as useful, but require alteration = most domains were rated >30% or at least 2 domains were >60%; and not recommended if most domains were rated