Evaluation of the Guidelines and Consensuses on Enuresis in Children Using the AGREEⅡand RIGHT Checklists

doi:10.12114/j.issn.1007-9572.2022.0424

Chinese General Practice ›› 2023, Vol. 26 ›› Issue (02): 134-141.DOI: 10.12114/j.issn.1007-9572.2022.0424

Special Issue: 指南/共识最新文章合辑；全科质控专项研究

• Guide·Evidence • Previous Articles Next Articles

Evaluation of the Guidelines and Consensuses on Enuresis in Children Using the AGREEⅡand RIGHT Checklists

¹Hospital of Chengdu University of TCM, Chengdu 610072, China
²Department of Chinese Medicinal Prescription, Chengdu University of Traditional Chinese Medicine, Chengdu 610075, China

Received:2022-03-09 Revised:2022-06-30 Published:2023-01-15 Online:2022-10-13
Contact: ZHANG Fenghua
About author:
SUN X J, XIAO X, WU X Y, et al. Evaluation of the guidelines and consensuses on enuresis in children using the AGREE Ⅱand RIGHT checklists [J] . Chinese General Practice, 2023, 26 (2) : 134-141.

小儿遗尿症指南和专家共识质量评价

¹610072　四川省成都市，成都中医药大学附属医院
²610075　四川省成都市，成都中医药大学方剂教研室

通讯作者: 张丰华
作者简介:
孙香娟，肖祥，吴宣諭，等.小儿遗尿症指南和专家共识质量评价[J].中国全科医学，2023，26（2）：134-141. [www.chinagp.net] 作者贡献：孙香娟提出研究思路，设计研究方案，提出研究命题，负责文献方法学质量评价，负责论文起草、初步撰写与修改；肖祥负责文献检索与筛选、文献方法学及报告质量评价、统计学分析；吴宣諭负责文献检索与筛选、文献方法学及报告质量评价；张丰华负责最终版本修订，文献方法学及报告质量评价，对论文负责。
基金资助:
国家自然科学基金青年基金项目(81503617); 四川省中医药管理局科学技术研究专项课题(2020LC0083)

Abstract

Abstract:

Background

Enuresis in children is a common pediatric disease that can significantly reduce the quality of life of children and their families. High-quality guidelines on enuresis in children contribute to the standardization of control and improvement of clinical symptoms. So developing relevant high-quality clinical practice guidelines is a critical way to improve the diagnosis and treatment of enuresis in children.

Objective

To evaluate the quality of guidelines and expert consensuses on enuresis in children issued since 2010 using the AGREE Ⅱ and RIGHT checklists, aiming at providing a reference for clinical practice and future development of relevant guidelines.

Methods

Guidelines and expert consensuses related to enuresis in children published from January 1, 2010 to January 31, 2022 were searched in databases of CNKI, Wanfang Data, VIP, CBM, and PubMed (with searching databases of MedLive, WHO and NICE as a supplement) . The AGREE Ⅱ and RIGHT checklists were used to evaluate the methodological and reporting quality of included studies. According to the AGREEⅡ, the recommended grade of each guideline/consensus was rated as "recommended (A) ", "recommended after update (B) ", and "not recommended (C) ". The intra-class correlation coefficient (ICC) was used for the consistency test.

Results

Altogether, eight guidelines and five consensuses were included, which provide 185 recommendations, including 44 for diagnosis and evaluation, 140 for treatment, and one for follow-up. By the AGREEⅡchecklist, these 13 studies were assessed with average scores of (66.99%±16.73%) , (46.26%±21.56%) , (34.42%±26.73%) , (60.36% ±32.13%) , (39.82%±20.14%) and (45.35%±37.93%) for scope and purpose, stakeholder involvement, rigour of development, clarity of presentation, applicability, and editorial independence, respectively. None of the studies were with recommendation grade A, eight were with recommendation grade B, and five were with grade C. The reporting rates of the studies in accordance with seven domains of basic information, background, evidence, recommendations, review and quality assurance, funding and declaration and management of interests and other information were (60.58%±12.19%) , (50.72%±20.18%) , (30.77%±26.88%) , (32.97%±27.53%) , 25.00% (40.63%) , (25.96%±24.00%) and 16.67% (33.33%) , respectively. The guidelines had higher score in terms of the scope and purpose domain of AGREEⅡ than consensuses (P<0.05) . The guidelines and consensuses had no significant differences in assessment results by each of the seven domains of RIGHT (P>0.05) . The ICC for the reliability of each of the domains of the AGREEⅡchecklist in assessment was greater than 0.750, showing a high consistency. The ICC for the reliability of each of the domains of the RIGHT checklist was 0.736, which showed a good consistency.

Conclusion

The overall methodological and reporting quality of the included guidelines and consensuses needs to be improved. The recommended grades of the included literature consist of B and C without A, suggesting that high-quality guidelines should be referred first when making clinical decisions. Currently, there is no guideline for the diagnosis and treatment of enuresis in children in primary care in China, and the quality of existing guideline on Traditional Chinese Medicine management of enuresis in children needs to be improved. It is suggested to develop relevant guidelines according to the AGREE Ⅱ and RIGHT checklists to guide the clinical management of enuresis in children.

Key words: Nocturnal enuresis, Child, Guidebook, Consensus, AGREEⅡ, RIGHT, Evaluation study, Research report

摘要：

背景

小儿遗尿症是儿科常见病之一，有效的小儿遗尿症诊疗指南有助于症状的规范化控制和缓解，而制定高质量的临床实践指南是提高小儿遗尿症诊疗水平的重要方式。

目的

基于AGREEⅡ和RIGHT工具，评价2010年以来国内外发布的小儿遗尿症指南和专家共识的质量，以期为临床实践及后续指南的制订提供参考。

方法

检索中国知网、万方数据知识服务平台、维普网、中国生物医学文献数据库和PubMed（补充检索医脉通、世界卫生组织以及英国国家临床示范研究所等数据库）2010-01-01至2022-01-31公开发表的小儿遗尿症相关的诊疗指南和专家共识。采用AGREEⅡ和RIGHT工具评价纳入文献的方法学和报告质量。根据AGREE Ⅱ工具评价结果，将各指南/共识推荐等级评定为"推荐（A级）""更新后推荐（B级）"和"不推荐（C级）"。使用组内相关系数（ICC）进行一致性评价。

结果

纳入8部指南和5部专家共识。共形成推荐意见185条，其中44条为诊断评估方面的意见，140条为治疗方面的推荐意见，1条为随访推荐意见。AGREEⅡ工具评价结果显示，范围和目的、参与人员、严谨性、清晰性、应用性和独立性6个领域的总得分（报告率）分别为（66.99%±16.73%）、（46.26%±21.56%）、（34.42%±26.73%）、（60.36%±32.13%）、（39.82%±20.14%）、（45.35%±37.93%），纳入的13篇文献中，无推荐等级为A的文献，推荐等级为B和C的文献分别为8篇和5篇。RIGHT工具评价结果显示，基本信息、背景、证据、推荐意见、评审和质量保证、资助与利益冲突声明和管理、其他方面7个领域的总得分（报告率）分别为（60.58%±12.19%）、（50.72%±20.18%）、（30.77%±26.88%）、（32.97%±27.53%）、25.00%（40.63%）、（25.96%±24.00%）、16.67%（33.33%）。AGREEⅡ工具评估结果中指南的范围和目的领域得分高于专家共识得分（P<0.05）。RIGHT工具评估中指南各领域得分与专家共识得分比较，差异均无统计学意义（P>0.05）。AGREEⅡ工具各领域一致性评价ICC均大于0.750，一致性较高；RIGHT工具各领域一致性评价ICC为0.736，一致性较好。

结论

本研究纳入的指南和专家共识总体方法学和报告质量均有待提高，纳入文献的推荐等级为B级和C级，缺少A级的文献，建议临床决策中优先参考高质量诊疗指南。目前尚无面向我国基层医师制定的小儿遗尿症诊疗指南，且现有的小儿遗尿症中医药管理指南证据质量有待提高，建议参照AGREE Ⅱ和RIGHT标准制定相关指南以指导小儿遗尿症的临床管理。

关键词: 夜间遗尿症, 儿童, 指南, 专家共识, AGREEⅡ, RIGHT, 评价研究, 研究报告

SUN Xiangjuan,XIAO Xiang,WU Xuanyu, et al. Evaluation of the Guidelines and Consensuses on Enuresis in Children Using the AGREEⅡand RIGHT Checklists[J]. Chinese General Practice, 2023, 26(02): 134-141. DOI: 10.12114/j.issn.1007-9572.2022.0424.
孙香娟,肖祥,吴宣諭等. 小儿遗尿症指南和专家共识质量评价[J]. 中国全科医学, 2023, 26(02): 134-141. DOI: 10.12114/j.issn.1007-9572.2022.0424.

Figures/Tables 3

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指南/专家共识	时间（年）	小儿NE类型	小儿NE定义	基金资助	利益冲突	更新
指南1^[7]	2015	MNE	无中枢神经系统病变的5岁以上儿童，在睡眠中出现不自主的漏尿现象，至少2次/周并持续≥3个月	未报告	未报告	未报告
指南2^[8]	2018	MNE	3岁以上小儿不能从睡眠中醒来而反复发生无意识排尿行为，每周超过一定次数，持续至少3个月	报告	报告	报告
指南3^[9]	2017	MNE	未指明	报告	报告	未报告
指南4^[10]	2012	MNE+NMNE	5岁以上儿童睡眠时间歇性尿失禁	未报告	报告	未报告
指南5^[11]	2020	MNE+NMNE	≥5岁儿童平均至少2次/周夜间不自主排尿，并持续3个月以上	未报告	未报告	报告
指南6^[12]	2020	MNE	5岁以上儿童在没有先天性或后天性泌尿系统或中枢神经系统缺陷，且无白天排尿症状的情况下，在睡眠期间突然排尿	未报告	报告	报告
指南7^[13]	2011	MNE+NMNE	≥5岁儿童平均至少2次/周夜间不自主排尿，并持续3个月以上	未报告	未报告	未报告
指南8^[14]	2010	MNE+NMNE	5~18岁的儿童和年轻人夜间睡眠时间非自愿尿床，没有固定的频率或病理生理限制	未报告	未报告	报告
专家共识1^[15]	2014	MNE	≥5岁儿童平均至少2次/周夜间不自主排尿，并持续3个月以上	未报告	未报告	未报告
专家共识2^[16]	2019	MNE+NMNE	5~6岁儿童至少发生2次/月夜间睡眠中不自主漏尿症状，7岁及以上儿童至少尿床1次/月，且连续3个月以上，没有明显精神和神经异常	报告	报告	未报告
专家共识3^[17]	2019	MNE	未指明	报告	报告	未报告
专家共识4^[18]	2019	MNE+NMNE	5岁以上儿童睡眠时间歇性尿失禁	未报告	未报告	未报告
专家共识5^[19]	2011	MNE+NMNE	未指明	未报告	报告	未报告

指南/专家共识	时间（年）	小儿NE类型	小儿NE定义	基金资助	利益冲突	更新
指南1^[7]	2015	MNE	无中枢神经系统病变的5岁以上儿童，在睡眠中出现不自主的漏尿现象，至少2次/周并持续≥3个月	未报告	未报告	未报告
指南2^[8]	2018	MNE	3岁以上小儿不能从睡眠中醒来而反复发生无意识排尿行为，每周超过一定次数，持续至少3个月	报告	报告	报告
指南3^[9]	2017	MNE	未指明	报告	报告	未报告
指南4^[10]	2012	MNE+NMNE	5岁以上儿童睡眠时间歇性尿失禁	未报告	报告	未报告
指南5^[11]	2020	MNE+NMNE	≥5岁儿童平均至少2次/周夜间不自主排尿，并持续3个月以上	未报告	未报告	报告
指南6^[12]	2020	MNE	5岁以上儿童在没有先天性或后天性泌尿系统或中枢神经系统缺陷，且无白天排尿症状的情况下，在睡眠期间突然排尿	未报告	报告	报告
指南7^[13]	2011	MNE+NMNE	≥5岁儿童平均至少2次/周夜间不自主排尿，并持续3个月以上	未报告	未报告	未报告
指南8^[14]	2010	MNE+NMNE	5~18岁的儿童和年轻人夜间睡眠时间非自愿尿床，没有固定的频率或病理生理限制	未报告	未报告	报告
专家共识1^[15]	2014	MNE	≥5岁儿童平均至少2次/周夜间不自主排尿，并持续3个月以上	未报告	未报告	未报告
专家共识2^[16]	2019	MNE+NMNE	5~6岁儿童至少发生2次/月夜间睡眠中不自主漏尿症状，7岁及以上儿童至少尿床1次/月，且连续3个月以上，没有明显精神和神经异常	报告	报告	未报告
专家共识3^[17]	2019	MNE	未指明	报告	报告	未报告
专家共识4^[18]	2019	MNE+NMNE	5岁以上儿童睡眠时间歇性尿失禁	未报告	未报告	未报告
专家共识5^[19]	2011	MNE+NMNE	未指明	未报告	报告	未报告

评价工具	领域	总得分（报告率）^a	指南得分（报告率）^a	指南1^[7]	指南2^[8]	指南3^[9]	指南4^[10]	指南5^[11]	指南6^[12]	指南7^[13]	指南8^[14]	专家共识得分（报告率）^a	专家共识1^[15]	专家共识2^[16]	专家共识3^[17]	专家共识4^[18]	专家共识5^[19]
AGREEⅡ	范围和目的	66.99±16.73	74.83±14.41	86.11	84.72	44.44	79.17	70.83	73.61	65.28	94.44	54.44±11.83	77.78	51.39	45.83	47.22	50.00
	参与人员	46.26±21.56	48.61±25.38	48.61	94.44	27.78	54.17	59.72	45.83	0	58.33	42.50±12.44	44.44	27.78	59.72	51.39	29.17
	严谨性	34.42±26.73	35.61±29.58	38.02	67.71	12.5	33.85	32.81	6.77	0	93.23	32.50±21.25	0	23.96	61.46	48.96	28.13
	清晰性	60.36±32.13	56.77±35.11	68.06	87.50	22.22	80.56	77.78	0	18.06	100	66.11±25.66	23.61	81.94	98.61	72.22	54.17
	应用性	39.82±20.14	35.81±22.25	55.21	0	27.08	65.63	52.08	4.17	43.75	38.54	46.25±13.97	37.5	45.83	70.83	47.92	29.17
	独立性	45.35±37.93	48.70±39.81	0	100.00	77.08	79.17	0	50.00	0	83.33	40.00±34.01	0	70.83	79.17	0	50.00
	推荐等级	—	—	B	B	C	B	B	C	C	B	—	C	B	B	B	C
RIGHT	基本信息	60.58±12.19	63.54±11.92	66.67	66.67	50	66.67	70.83	62.5	41.67	83.33	55.83±11.06	50.00	70.00	58.33	54.17	41.67
	背景	50.72±20.18	52.34±24.99	56.25	50.00	21.88	71.88	46.88	56.25	15.63	100.00	48.13±7.02	50.00	50.00	59.38	40.63	40.63
	证据	30.77±26.88	36.88±31.12	65.00	45.00	5.00	0	35.00	30.00	15.00	100.00	21.00±13.19	0	20.00	15.00	35.00	35.00
	推荐意见	32.97±27.53	37.50±31.44	21.43	75.00	7.14	50.00	50.00	7.14	0	89.29	25.71±17.41	0	21.43	50.00	39.29	17.86
	评审和质量保证	25.00（40.63）	34.38±30.46	0	50.00	25.00	25.00	50.00	25.00	0	100.00	0（0）	0	0	37.5	0	0
	资助与利益冲突声明和管理	25.96±24.00	28.13±25.39	0	62.5	37.5	43.75	0	18.75	0	62.5	22.50±21.14	0	50	43.75	0	18.75
	其他方面	16.67（33.33）	16.67（33.33）	0	0	33.33	16.67	33.33	0	16.67	66.67	0（33.33）	0	0	58.33	0	33.33

评价工具	领域	总得分（报告率）^a	指南得分（报告率）^a	指南1^[7]	指南2^[8]	指南3^[9]	指南4^[10]	指南5^[11]	指南6^[12]	指南7^[13]	指南8^[14]	专家共识得分（报告率）^a	专家共识1^[15]	专家共识2^[16]	专家共识3^[17]	专家共识4^[18]	专家共识5^[19]
AGREEⅡ	范围和目的	66.99±16.73	74.83±14.41	86.11	84.72	44.44	79.17	70.83	73.61	65.28	94.44	54.44±11.83	77.78	51.39	45.83	47.22	50.00
	参与人员	46.26±21.56	48.61±25.38	48.61	94.44	27.78	54.17	59.72	45.83	0	58.33	42.50±12.44	44.44	27.78	59.72	51.39	29.17
	严谨性	34.42±26.73	35.61±29.58	38.02	67.71	12.5	33.85	32.81	6.77	0	93.23	32.50±21.25	0	23.96	61.46	48.96	28.13
	清晰性	60.36±32.13	56.77±35.11	68.06	87.50	22.22	80.56	77.78	0	18.06	100	66.11±25.66	23.61	81.94	98.61	72.22	54.17
	应用性	39.82±20.14	35.81±22.25	55.21	0	27.08	65.63	52.08	4.17	43.75	38.54	46.25±13.97	37.5	45.83	70.83	47.92	29.17
	独立性	45.35±37.93	48.70±39.81	0	100.00	77.08	79.17	0	50.00	0	83.33	40.00±34.01	0	70.83	79.17	0	50.00
	推荐等级	—	—	B	B	C	B	B	C	C	B	—	C	B	B	B	C
RIGHT	基本信息	60.58±12.19	63.54±11.92	66.67	66.67	50	66.67	70.83	62.5	41.67	83.33	55.83±11.06	50.00	70.00	58.33	54.17	41.67
	背景	50.72±20.18	52.34±24.99	56.25	50.00	21.88	71.88	46.88	56.25	15.63	100.00	48.13±7.02	50.00	50.00	59.38	40.63	40.63
	证据	30.77±26.88	36.88±31.12	65.00	45.00	5.00	0	35.00	30.00	15.00	100.00	21.00±13.19	0	20.00	15.00	35.00	35.00
	推荐意见	32.97±27.53	37.50±31.44	21.43	75.00	7.14	50.00	50.00	7.14	0	89.29	25.71±17.41	0	21.43	50.00	39.29	17.86
	评审和质量保证	25.00（40.63）	34.38±30.46	0	50.00	25.00	25.00	50.00	25.00	0	100.00	0（0）	0	0	37.5	0	0
	资助与利益冲突声明和管理	25.96±24.00	28.13±25.39	0	62.5	37.5	43.75	0	18.75	0	62.5	22.50±21.14	0	50	43.75	0	18.75
	其他方面	16.67（33.33）	16.67（33.33）	0	0	33.33	16.67	33.33	0	16.67	66.67	0（33.33）	0	0	58.33	0	33.33

Evaluation of the Guidelines and Consensuses on Enuresis in Children Using the AGREEⅡand RIGHT Checklists

小儿遗尿症指南和专家共识质量评价

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