Systematic identification and quality appraisal of guidelines developed for the pediatric population in India

Abstract

BackgroundWell-developed clinical practice guidelines are the cornerstone of evidence-based healthcare practice and policy. ObjectiveThis study was undertaken to systematically identify clinical practice guidelines developed in India for the pediatric age group, and appraise their methodological quality. MethodsWe conducted a systematic review to identify all Indian guidelines designed for implementation in the pediatric age group. We searched databases of published literature, and websites of national agencies, and used a step-wise approach to screen titles, abstracts and full-texts of eligible publications. We appraised the methodological quality of the included guidelines using the standard AGREE II (Appraisal of Guidelines Research and Evaluation) checklist, scoring each guideline across six domains. ResultsThe literature search identified 10,959 citations. Step-wise screening resulted in the inclusion of 138 Indian guideline documents, pertaining to pediatric care. The overall AGREE II score of the included guidelines ranged from 12 to 72.5%, the median (IQR) being 30% (24.6, 37). Only 2 (1.4%) guidelines scored above 60%. There was wide variation in the scores across quality appraisal domains. The domain-wise median (IQR) scores were as follows. Scope and purpose: 50% (43, 66.7), Stakeholder involvement: 44.5% (39, 50), Rigor of development: 12.5% (8, 23.4), Clarity of presentation: 50% (39, 61), Applicability: 0% (0, 12.5), and Editorial independence: 66.7% (0, 67). Although guidelines published during 2011–2020 had higher quality scores (compared to previous decades), there was no significant further improvement from 2021 onwards. ConclusionThis study identified overall low methodological quality of Indian pediatric guidelines, and suggests urgent need for improvement.