Quality and concordance of international paediatric sepsis guidelines: a cross-sectional appraisal from the SENTINEL International study
Abstract
Objectives To evaluate the methodological quality of hospital-specific paediatric sepsis clinical practice guidelines (CPGs) from sites participating in an international study using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool and to assess the consistency of treatment recommendations and concordance with the Surviving Sepsis Campaign 2020 (SSC 2020) international reference standard. Design Cross-sectional appraisal of hospital-specific CPGs. Setting Hospital sites participating in the Sepsis Epidemiology in Paediatric Acute Care International Study across five continents. Participants Hospital-specific CPGs for the acute care management of paediatric sepsis. Interventions Hospital-specific CPGs were appraised independently using the AGREE II tool and classified as high, moderate or low quality. Consistency across guidelines and concordance with SSC 2020 were assessed for 12 key treatment recommendations. Main outcome measures AGREE II domain scores and overall quality rating; consistency of treatment recommendations across hospital-specific CPGs; concordance of individual CPGs with SSC 2020. Results 14 hospital-specific CPGs from 13 countries were included. All were rated as low methodological quality overall; the rigour of development (range: 0–50%) and editorial independence (0–58%) were the lowest scoring AGREE II domains. CPG concordance with SSC 2020 ranged from 42% to 100%; consistency across the 12 treatment recommendations ranged from 43% (steroid indications) to 93% (initial laboratory investigations, time to antibiotics and fluid bolus volume). Conclusions Despite all hospital-specific CPGs across an international cohort being of low methodological quality, most aligned with SSC 2020 for key time-critical recommendations. Clinically important variations existed in fluid resuscitation composition and timing of steroid administration. Trial registration number ACTRN12621000920097.
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Authors: Tom Solan, Amanda Williams, Shane George, Adin Breuer, Stephen Hearps, Adriana Yock‐Corrales, Viviana Pavlicich, Kandamaran Krishnamurthy, Yashica Seymour-Hanna, Radhika Raman, Bharat Choudhary, Weda Kusuma, Victoria Ribaya, Nathan Forsyth, Nilanka Mudithakumara, Nichkamol Lertamornkitti, Antionette David, Suleiman Mohamed, Tigist Bacha, Jenala Njirammadzi-Maleta, John Appiah, Janvier Hitayezu, Mukami Kunga, Genevieve P. G. Fung, Rahimi Abdrazak, Shu‐Ling Chong, Jhong-Lin Wu, Jeong-Yong Lee, Damian Roland, Silvia Bressan, Ruth Logan, Yolanda Ballestero, Özlem Tekşam, Lina Jankauskaitė, Graham Thompson, Vikram Sabhaney, Yasaman Shayan, Elysha Pifko, J. Lloyd, Khalid Al Ansari, Franz E Babl, Elliot Long
Institutions: University of Padua, The University of Melbourne, Nationwide Children's Hospital, Siriraj Hospital, Mahidol University, Nemours Children's Health System, Chinese University of Hong Kong, Karolinska University Hospital, Lithuanian University of Health Sciences, Asan Medical Center, Hacettepe University, Royal Children's Hospital, BC Children's Hospital, Alberta Children's Hospital, Centre Hospitalier Universitaire Sainte-Justine, Griffith University, Murdoch Children's Research Institute, National Taiwan University Hospital, All India Institute of Medical Sciences Jodhpur, University Hospitals of Leicester NHS Trust, University of Kigali, University of Leicester, Gold Coast Hospital, St. Paul's Hospital Millennium Medical College, St. Luke's Medical Center, Kamuzu Central Hospital, Komfo Anokye Teaching Hospital, Kamuzu University of Health Sciences, Muhimbili National Hospital, Rumah Sakit Umum Pusat Dr. Sardjito, Hospital de Cruces, Centre Hospitalier Universitaire de Kigali, Tengku Ampuan Rahimah Hospital, Queen Elizabeth Hospital, Kenyatta National Hospital, Sidra Medical and Research Center, KK Women's and Children's Hospital, Hospital Nacional de Niños, Alfred I. duPont Hospital for Children, Universidad del Pacífico, Princess Margaret Hospital, College of The Bahamas, Kanchi Kamakoti CHILDS Trust Hospital, Lady Ridgeway Hospital for Children, Nairobi Hospital