Clinical Practice Guidelines for COVID-19 Management in Children Are Inconsistent

Results of a review of clinical practice guidelines (CPGs) for the management of COVID-19 infection in children found heterogeneous recommendations and justifications. These findings were published in Travel Medicine and Infectious Disease.

Researchers included any documents published between January and October 2021 that claimed to be CPGs and described the process used to issue the recommendations therein. The quality of the documents was assessed using the Appraisal of Guidelines for Research and Evaluation II (AGREE-II).

The AGREE-II comprises 23 items from 6 domains, including scope and purpose, stakeholder involvement, rigor of development, clarity and presentation, applicability, and editorial independence. Each CPG was independently reviewed and scored by 2 researchers, with the mean of the 2 scores used in the final analysis. Disagreements were adjudicated via further discussion between the researchers until a consensus was reached. The AGREE-II Instrument guideline was used to calculate scores for each domain. The threshold for acceptable quality was an overall score equal to or greater than 70%.

Overall, 5 CPGs met the inclusion criteria, which were authored by the following institutions: American College of Rheumatology, Spanish Pediatric Association, National Institutes of Health, Swiss Society of Intensive Care Medicine and the Pediatric Infectious Diseases Group of Switzerland, and the Australian National Health and Medical Research Council.

Among the 5 CPGs assessed, the median AGREE-II score across all domains was 61% (range, 49%-72%). For the domain of rigor of methodological development alone, the median score was 52% (range, 25%-88%). The CPG authored by the Spanish Pediatric Association was the only CPG to score above 70% across all 6 domains, with scores of 88% overall and 100% for the methodological development domain. The only other CPG to score higher than 70% overall was authored by the Australian National Health and Medical Research Council, which received an overall score of 84%.

Among all CPGs, recommendations for remdesivir, tocilizumab, and intravenous immunoglobulin varied. Variations among the 5 CPGs also were observed for the methodologies used to present evidence, assess the harms and benefits associated with the treatment recommendations, and to issue the recommendations.  

This study was limited as only CPGs with justifications for recommendations were included in the analysis, thus the results cannot be generalized to all CPGs for COVID-19 infection management in children.

According to the researchers, “some CPGs did not clearly present the benefits/harms, and no CPG seems to have used a structured decision-making framework.” Adding that, “future CPGs should describe in detail their evidence-to-decision process to issue reliable and transparent recommendations.”

Reference

Quincho-Lopez A, Chávez-Rimache  l, Montes-Alvis J, Taype-Rondan  A, Alvarado-Gamarra  G. Characteristics and conflicting recommendations of clinical practice guidelines for COVID-19 management in children: A scoping review. Travel Med Infect Dis. Published online May 7, 2022. doi:10.1016/j.tmaid.2022.102354