A systematic critical appraisal of evidence-based clinical practice
guidelines for the management of pregnant women with sickle cell disease
using the Appraisal of Guidelines for REsearch and Evaluation II (AGREE
II) instrument.
Abstract
Rationale, aims, and objectives: Management of pregnant women with
sickle cell disease (SCD) represents a challenge to maternal healthcare
services due to its potential complications with associated morbidity
and mortality. Trustworthy evidence-based clinical practice guidelines
(CPGs) have a major impact on supporting appropriate healthcare positive
outcomes. The objective of this study was to critically appraise the
quality of recent CPGs for SCD in pregnancy. Methods: We identified
clinical questions and eligibility criteria, searched, and screened for
CPGs using CPG databases, DynaMed, PubMed, and Google Scholar. Each
included CPG was appraised by four independent appraisers using the
Appraisal of Guidelines for REsearch & Evaluation II (AGREE-II)
instrument. An additional inter-rater analysis was conducted. Results:
Four eligible CPGs were appraised: American College of Obstetricians and
Gynecologists (ACOG); National Heart, Lung, and Blood Institute (NHLBI);
National Institute of Health and Care Excellence (NICE); and Royal
College of Obstetricians and Gynaecologists (RCOG). The AGREE-II
standardized domain scores revealed variation between the quality of
these CPGs. Overall, the recommendations were not significantly
different between these four CPGs. Conclusions: In recent years, there
has been an improvement in the reporting of CPG development methodology.
CPG development working groups should aim to adhere to the AGREE II
criteria to improve the standards and quality of CPGs. RCOG followed by
NHLBI CPGs showed the highest quality and were strongly recommended. We
recommend incorporating AGREE-II appraisal of CPGs in the education of
obstetricians, gynecologists and hematologists to guide their selection
of CPGs for their daily practice.