Login to Access Video or Poster Abstract: MP61-12
Sources of Funding: none

Introduction

There are many clinical practice guidelines (CPGs) published recently pertaining to the management of pediatric urinary tract infection (pUTI). Concerns regarding the quality, credibility and applicability of these CPGs have been raised due to the inconsistencies of recommendations between them. We hypothesized that these differences may be due to variation in the quality of the guideline development process therefore the aim of this project was to determine the quality of the CPGs on pUTI using AGREE II (Appraisal of Guidelines Research and Evaluation) instrument.

Methods

A systematic literature search was performed to identify CPGs for pUTI published from 2007-2016. Eligible CPGs were independently assessed and appraised by 5 physician reviewers using AGREE II tool. The CPGs were assessed for domains and summarized for overall quality by each reviewer. The appraisal score for each guideline was extrapolated for each AGREE domain and in overall total. CPGs were then ranked accordingly and domains were assessed for quality. Domain score less than 70 is considered low. Inter-rater reliability was assessed using Inter-class coefficient (ICC) and statistical significance was set at 0.5.

Results

A total of 13 CPGs were critically reviewed. Amongst the 5 reviewers, there was a high degree of inter-rater reliability. The average measure ICC was 0.922 with a 95% confidence interval from 0.826 to .0.973 (F(12,48)= 12.806, p<.0001). The Spanish guideline for pediatric UTI, American Association of Pediatrics (AAP) and National Institute for Health and Clinical Excellence (NICE) guidelines consistently scored high on all AGREE domains. 10/13 CPGs had scores <70 for the domains of applicability, while the domains of stakeholder involvement and rigor of development were low in 9 CPGs.

Conclusions

The CPGs from Spain, AAP and NICE scored highly on the AGREE II indicators of quality of the CPG development process. Domains of applicability, stakeholder involvement and rigor of development were suboptimal quality wise in the majority of the most recently available CPGs for pUTI. This leads to potential confusion for the intended audience for whom these guidelines have been developed. Clinicians are recommended to consider these findings when selecting pUTI guidelines for use in practice.

Funding

none