Methodological rigor and reporting quality of clinical practice guidelines for adults hospitalized with bacterial pneumonia: a scoping review.

Abstract

Objective: This scoping review describes the methodological rigor and reporting quality of clinical practice guidelines (CPGs) for adults hospitalized with bacterial pneumonia.

Introduction: Health care professionals rely on CPGs as authoritative sources for evidence-based treatment recommendations. To increase awareness of the current state of guideline rigor and reporting quality, this scoping review focused on the management of bacterial pneumonia in hospitalized adults.

Eligibility criteria: This review included national and international CPGs for the care of adult and older adult patients (18 years or above) who were male, female, or gender-diverse and hospitalized with bacterial pneumonia. Guidelines published between 2017 and 2022 for adult patients with multiple diagnoses/comorbidities were included if the primary focus was management of bacterial pneumonia in the inpatient, hospital setting.

Methods: A 3-step search was conducted following the JBI methodology for scoping reviews. A total of 1533 records was identified: 1524 from 8 databases (ie, CINAHL [EBSCOhost], Cochrane Database of Systematic Reviews, Embase [Embase.com], Epistemonikos, Google Scholar, JBI Evidence Synthesis, PubMed, Web of Science Core Collection), and 9 from other sources (professional organizations [n=6], citation searching [n=3]). Following deduplication, 1293 titles and abstracts were screened, and 1232 were excluded. One guideline from other sources (ie, citation searching) was excluded because it was out of print and unavailable. Full-text screening was completed on 69 guidelines to determine eligibility (databases [61], other sources [8]). Of these, 54 guidelines were excluded as duplicate records, ineligible populations, or ineligible concepts. The remaining 15 national and international guidelines were included.

Results: Guidelines were authored in 13 different countries (5 continents). All guidelines were endorsed by at least 1 professional organization, and 9 guidelines were endorsed by 2 or more organizations. Most guidelines were published in English, although, German, Russian, and Spanish guidelines were also included. The results for the AGREE II Domain 3, Rigor of Development, showed a mean score of 56% (range 15% to 90%). The AGREE II scores showed significant variability within and across all domains, which affected results of overall assessment (6 guidelines were rated high quality, 7 were rated sufficient, 2 were rated low) and reviewers' recommendations on use (2 guidelines were recommended for use in current form, 11 with modifications prior to use, and 2 were not recommended for use in current form). The RIGHT Checklist showed that 64% of guidelines included information on evidence and 56% included clear treatment recommendations. The AGREE Reporting Checklist showed that 4 guidelines addressed 1 focal area (evidence selection [n=2], monitoring/auditing criteria to measure application of guideline recommendations [n=1], updating the procedure [n=1]).

Conclusion: Methodological rigor and reporting quality of guidelines cannot be presumed. This scoping review showed deficiencies in 13 of 15 guidelines. Significant areas of weakness were found in the areas of rigor of development, evidence information, stakeholder involvement, applicability, recommendation information, review and quality assurance information, funding and declaration of conflicts of interest, and updating the procedure. These results underscore the need for guideline developers to use standardized appraisal instruments during development and reporting. Developers should include detailed, final self-assessments alongside the published guidelines to enhance transparency, foster trust, and, ultimately, support the delivery of high-quality patient care. It is the responsibility of guideline authors, endorsing organizations, journal editors and publishers, and health care providers to assess these qualities prior to dissemination and use.

Review registration: OSF https://osf.io/h896x/.