TY - JOUR
T1 - Quality of clinical practice guidelines about red blood cell transfusion
AU - Simancas-Racines, Daniel
AU - Montero-Oleas, Nadia
AU - Vernooij, Robin W.M.
AU - Arevalo-Rodriguez, Ingrid
AU - Fuentes, Paulina
AU - Gich, Ignasi
AU - Hidalgo, Ricardo
AU - Martinez-Zapata, Maria José
AU - Bonfill, Xavier
AU - Alonso-Coello, Pablo
PY - 2019/5/1
Y1 - 2019/5/1
N2 - © 2018 The Authors. Journal of Evidence-Based Medicine published by Chinese Cochrane Center, West China Hospital of Sichuan University and John Wiley & Sons Australia, Ltd Background: Red blood cell (RBC) transfusions are essential in health care. The quality of recommendations included in clinical practice guidelines (CPG), regarding this intervention, has not been systematically evaluated. This paper systematically assessed CPGs for RBC-transfusion, to appraise their methodological quality, to explore changes in quality over time, and to assess the consistency of the hemoglobin threshold (HT) recommendations. Methods: We searched for CPGs that included recommendations of RBC-transfusion in generic databases, compiler entities, registries, clearinghouses and guideline developers. Three reviewers extracted data on CPGs characteristics and HT recommendations, independently appraised the quality of the studies using AGREE II and resolved disagreements by consensus. Results: We examined 16 CPGs. Mean scores (mean ± SD) were: scope and purpose (59.4% ± 19.8%), stakeholder involvement (43.2% ± 22.6%), rigor of development (50% ± 25%), clarity of presentation (74.4% ± 12.6%), applicability (19.4% ± 18.8%), and editorial independence (41% ± 30%). Seven CPGs recommended a restrictive strategy for RBC transfusion; four CPGs gave a guarded statement considering an HT of 7 g/dL, as safe to prescribe an RBC transfusion. Eight CPGs did not provide an HT stating that RBC transfusions should not be prescribed by HT alone. Conclusions: Only 3 out of the 16 evaluated CPGs were “recommended” by the independent evaluators. Four domains “stakeholder involvement,” “rigor of development,” applicability,” and “editorial independence” had serious shortcomings. Recommendations about the use of an HT for RBC-transfusion were heterogeneous among guidelines. Greater efforts are needed to provide high-quality CPGs in the RBC-transfusion practice.
AB - © 2018 The Authors. Journal of Evidence-Based Medicine published by Chinese Cochrane Center, West China Hospital of Sichuan University and John Wiley & Sons Australia, Ltd Background: Red blood cell (RBC) transfusions are essential in health care. The quality of recommendations included in clinical practice guidelines (CPG), regarding this intervention, has not been systematically evaluated. This paper systematically assessed CPGs for RBC-transfusion, to appraise their methodological quality, to explore changes in quality over time, and to assess the consistency of the hemoglobin threshold (HT) recommendations. Methods: We searched for CPGs that included recommendations of RBC-transfusion in generic databases, compiler entities, registries, clearinghouses and guideline developers. Three reviewers extracted data on CPGs characteristics and HT recommendations, independently appraised the quality of the studies using AGREE II and resolved disagreements by consensus. Results: We examined 16 CPGs. Mean scores (mean ± SD) were: scope and purpose (59.4% ± 19.8%), stakeholder involvement (43.2% ± 22.6%), rigor of development (50% ± 25%), clarity of presentation (74.4% ± 12.6%), applicability (19.4% ± 18.8%), and editorial independence (41% ± 30%). Seven CPGs recommended a restrictive strategy for RBC transfusion; four CPGs gave a guarded statement considering an HT of 7 g/dL, as safe to prescribe an RBC transfusion. Eight CPGs did not provide an HT stating that RBC transfusions should not be prescribed by HT alone. Conclusions: Only 3 out of the 16 evaluated CPGs were “recommended” by the independent evaluators. Four domains “stakeholder involvement,” “rigor of development,” applicability,” and “editorial independence” had serious shortcomings. Recommendations about the use of an HT for RBC-transfusion were heterogeneous among guidelines. Greater efforts are needed to provide high-quality CPGs in the RBC-transfusion practice.
KW - blood transfusion
KW - clinical practice guidelines
KW - red blood cells
KW - systematic review
U2 - https://doi.org/10.1111/jebm.12330
DO - https://doi.org/10.1111/jebm.12330
M3 - Article
C2 - 30511477
VL - 12
SP - 113
EP - 124
JO - Journal of Evidence-Based Medicine
JF - Journal of Evidence-Based Medicine
SN - 1756-5383
ER -