Clinical practice guidelines and recommendations in the context of the COVID-19 pandemic: systematic review and critical appraisal

  1. Tanja A Stamm
  2. Margaret R Andrews
  3. Erika Mosor
  4. Valentin Ritschl
  5. Linda C Li
  6. Jasmin K Ma
  7. Adalberto Campo Arias
  8. Sarah Baker
  9. Nicola W Burton
  10. Mohammad Eghbali
  11. Natalia Fernandez
  12. Ricardo Ferreira
  13. Gabriele Gäbler
  14. Souzi Makri
  15. Sandra Mintz
  16. Rikke Moe
  17. Elizabeth Morasso
  18. Susan L Murphy
  19. Simiso Ntuli
  20. Maisa Omara
  21. Miguel Angel Simancas Pallares
  22. Jen Horonieff
  23. Gerald Gartlehner
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Abstract

Background

The number of published clinical practice guidelines and recommendations related to SARS-CoV-2 infections causing COVID-19 has rapidly increased. However, insufficient consideration of appropriate methodologies in the guideline development could lead to misleading information, uncertainty among professionals, and potentially harmful actions for patients.

Purpose

Rapid systematic review of clinical practice guidelines and recommendations in the context of COVID-19 to explore if basic methodological standards of guideline development have been met.

Data sources

MEDLINE [PubMed], CINAHL [Ebsco], Trip and manual search; from Feb 1st 2020 until April 27th 2020.

Study selection

All types of healthcare workers providing any kind of healthcare to any patient population in any setting.

Data extraction

At least two reviewers independently extracted guideline characteristics, conducted critical appraisal according to The Appraisal of Guidelines for Research and Evaluation Instrument (AGREE II) and classified the guidelines using the Association of the Scientific Medical Societies (AWMF) Guidance Manual and Rules for Guideline Development. We plan six-month updates (living review).

Data synthesis

There were 1342 titles screened and 188 guidelines included. The highest average AGREE II domain score was 89% for scope and purpose, the lowest for rigor of development (25%). Only eight guidelines (4%) were based on a systematic literature search and a structured consensus process by representative experts (classified as the highest methodological quality, S3 according to AWMF). Patients were only included in the development of one guideline. A process for regular updates was described in 27 guidelines (14%).

Limitations

Methodological focus only.

Conclusions

Despite clear scope, most publications fell short of basic methodological standards of guideline development. Future research should monitor the evolving methodological quality of the guidelines and their updates over time.

Registration/Publication

The protocol was published at <ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="http://www.researchgate.net">www.researchgate.net</ext-link>, DOI: 10.13140/RG.2.2.21293.51689. Preliminary results are publicly available on medRxiv.

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