Quality Appraisal and Content Analysis of Clinical Practice Guidelines for Chronic Rhinosinusitis

doi:10.12114/j.issn.1007-9572.2020.00.224

Abstract

Abstract: Background　Chronic rhinosinusitis（CRS） is a high-incidence disease in the ENT Department，which causes severe sufferings and economic burden on patients.However，there are differences in the recommendations of the current clinical practice guidelines（CPGs） for the diagnosis and treatment of CRS at home and abroad.Objective　To assess the quality of CPGs for CRS and analyze the treatment recommendations，in order to provide advice for the development of guidelines and the adoption of recommendations.Methods　Literatures were retrieved in the Chinese and English databases and professional guideline websites in February，2019 and the references were tracked to screen recommendations on the treatment of CRS in adolescents and adults in CPGs.The retrieval time was from the date the database was built to the date when the retrieval started.The methodological quality was appraised by the AGREE II instrument and the reporting quality was evaluated using RIGHT checklist.Then the bubble chart and mind mapping were produced to compare and analyze the treatment recommendations on CRS.Results　Eight CPGs were included.The average total score of AGREE II was 48.76%（30.90%-73.09%），only two guidelines were strongly recommended（score>60%），and the other six were recommended after revision.The overall report rate of right items was 34.29%-65.71%，among which the report rate of review and quality control was 0.The consistent treatment methods recommended by CPGs were corticosteroids，nasal saline irrigation and endoscopic surgery，oral antihistamines for allergy suffers.Optional treatments included bacterial lysate，mucolytic agents，proton pump inhibitors，phytotherapy，capsaicin，leucine antagonists，nasal furosemide，nasal saline irrigation with xylitol，nasal saline irrigation with sodium hypochlorite，and nasal saline irrigation with baby shampoo.While there were some conflicts on the use of antibiotics，decongestants，leukotriene receptor antagonists，anti-IgE and aspirin desensitisation for aspirin exacerbated respiratory disease.Conclusion　There is still room for the formulation of CPGs and the quality of the reporting.It is recommended to adopt patient preference，use unified tools for evidence and recommendations evaluation，and consider the applicability.Recommendations from a more rigorous CPG should be considered primarily in clinical practice，in case of conflicting recommendations.

Key words: Chronic rhinosinusitis, Guideline, Quality appraisal, AGREE II, RIGHT

摘要： 背景　慢性鼻窦炎是耳鼻喉科高发疾病，对患者造成严重的影响和经济负担，但目前国内外慢性鼻窦炎诊疗指南推荐意见存在差异。目的　对慢性鼻窦炎诊疗指南进行质量评价并分析其治疗意见，为指南制定和推荐意见的采纳提供建议。方法　于2019年2月检索中英文数据库和各专业指南网站获取相关文献，同时追踪参考文献，筛选适用于青少年及成年人的推荐意见中包含对慢性鼻窦炎的治疗意见的指南。检索时间为建库至检索日期。使用临床指南研究与评估系统Ⅱ（AGREE Ⅱ）和卫生保健实践指南报告清单（RIGHT）对纳入指南的方法学质量和报告质量进行评价，并绘制气泡图和思维导图，对比分析关于慢性鼻窦炎治疗的推荐意见。结果　最终纳入8部指南，AGREE Ⅱ评价总分平均为48.76%（30.90%~73.09%），仅2部指南强烈推荐使用（得分>60%），其余6部需修订后推荐。RIGHT条目总体报告率为34.29%~65.71%，其中评审和质量控制方面报告率均为0。指南推荐一致的治疗方法包括皮质类固醇、鼻腔盐水冲洗和手术治疗，以及过敏者口服抗组胺药，可选用的措施包括细菌溶解物、黏痰溶解药、质子泵抑制剂、植物疗法、辣椒素、亮氨酸拮抗剂、鼻用呋塞米、木糖醇盐水冲洗液、次氯酸钠盐水冲洗液、含婴儿香波的盐水冲洗液，尚无统一观点的治疗措施包括抗生素、减充血剂、白三烯受体拮抗剂、IgE拮抗剂及阿司匹林加重呼吸系统疾病患者阿司匹林脱敏治疗。结论　现有慢性鼻窦炎诊疗指南制定方法及其报告质量需提高，建议纳入患者的偏好、使用统一的评价工具和考虑运用性。推荐意见有冲突时，建议参考制定方法更为严谨的指南。

关键词: 慢性鼻窦炎, 指南, 质量评价, 临床指南研究与评估系统Ⅱ, 卫生保健实践指南报告清单

CHEN Ji,SUN Yue,GAO Ya, et al. Quality Appraisal and Content Analysis of Clinical Practice Guidelines for Chronic Rhinosinusitis　[J]. Chinese General Practice, 2020, 23(13): 1583-1591. DOI: 10.12114/j.issn.1007-9572.2020.00.224.
陈吉,孙月,高亚等. 慢性鼻窦炎指南的评价与内容分析[J]. 中国全科医学, 2020, 23(13): 1583-1591. DOI: 10.12114/j.issn.1007-9572.2020.00.224.

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