TY - JOUR
T1 - Nutrition in critically ill adults
T2 - A systematic quality assessment of clinical practice guidelines
AU - Fuentes Padilla, Paulina
AU - Martínez, Gabriel
AU - Vernooij, Robin W M
AU - Cosp, Xavier Bonfill
AU - Alonso-Coello, Pablo
N1 - Copyright © 2016 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.
PY - 2016/12
Y1 - 2016/12
N2 - BACKGROUND & AIMS: Nutritional support in the acutely ill is a complex topic. Clinical practice guidelines (CPGs) have been developed to assist healthcare professionals working in this field. However, the quality of these clinical guidelines has not yet been systematically assessed. The objective of our study was to identify and assess the quality of CPGs on nutrition in critically ill adult patients.METHODS: We performed a systematic search to identify CPGs on nutrition in critically ill adult patients. Three independent appraisers assessed six domains (scope and purpose, stakeholder involvement, rigour of development, clarity of presentation, applicability and editorial independence) of the eligible CPGs using the Appraisal of Guidelines, Research, and Evaluation II (AGREE II) instrument.RESULTS: Nine CPGs were selected. Overall agreement among appraisers was very good (ICC: 0.853; 95% CI: 0.820-0.881). The mean scores for each AGREE domain were the following: "scope and purpose" 76.2% ± 13.7%; "stakeholder involvement" 42.8% ± 16.5%; "rigour of development" 57.9% ± 18.1%; "clarity of presentation" 76.9% ± 13.7%; "applicability" 30.1% ± 22.8%; and 42.1% ± 23.9% for "editorial independence". Four CPGs were deemed "Recommended"; three "Recommended with modifications"; and two "Not recommended". We did not observe improvement over time in the overall quality of the CPGs.CONCLUSIONS: The overall quality of CPGs on nutrition in critically ill adults is suboptimal, with only four CPGs being recommended for clinical use. Our results highlight the need to revise and improve CPG development processes in this field.
AB - BACKGROUND & AIMS: Nutritional support in the acutely ill is a complex topic. Clinical practice guidelines (CPGs) have been developed to assist healthcare professionals working in this field. However, the quality of these clinical guidelines has not yet been systematically assessed. The objective of our study was to identify and assess the quality of CPGs on nutrition in critically ill adult patients.METHODS: We performed a systematic search to identify CPGs on nutrition in critically ill adult patients. Three independent appraisers assessed six domains (scope and purpose, stakeholder involvement, rigour of development, clarity of presentation, applicability and editorial independence) of the eligible CPGs using the Appraisal of Guidelines, Research, and Evaluation II (AGREE II) instrument.RESULTS: Nine CPGs were selected. Overall agreement among appraisers was very good (ICC: 0.853; 95% CI: 0.820-0.881). The mean scores for each AGREE domain were the following: "scope and purpose" 76.2% ± 13.7%; "stakeholder involvement" 42.8% ± 16.5%; "rigour of development" 57.9% ± 18.1%; "clarity of presentation" 76.9% ± 13.7%; "applicability" 30.1% ± 22.8%; and 42.1% ± 23.9% for "editorial independence". Four CPGs were deemed "Recommended"; three "Recommended with modifications"; and two "Not recommended". We did not observe improvement over time in the overall quality of the CPGs.CONCLUSIONS: The overall quality of CPGs on nutrition in critically ill adults is suboptimal, with only four CPGs being recommended for clinical use. Our results highlight the need to revise and improve CPG development processes in this field.
KW - Adult
KW - Critical Illness/therapy
KW - Humans
KW - Nutrition Therapy/methods
KW - Nutritional Status
KW - Practice Guidelines as Topic/standards
KW - Quality Assurance, Health Care
U2 - 10.1016/j.clnu.2016.03.005
DO - 10.1016/j.clnu.2016.03.005
M3 - Review article
C2 - 27068586
SN - 0261-5614
VL - 35
SP - 1219
EP - 1225
JO - Clinical Nutrition
JF - Clinical Nutrition
IS - 6
ER -