Tom Solan, Amanda Williams, Shane George, Adin Breuer, Stephen Hearps, Adriana Yock-Corrales, Viviana Pavlicich, Kandamaran Krishnamurthy, Yashica Seymour-Hanna, Radhika Raman, Bharat Choudhary, Weda Kusuma, Victoria Ribaya, Nathan Forsyth, Nilanka Mudithakumara, Nichkamol Lertamornkitti, Antionette David, Suleiman Mohamed, Tigist Bacha, Jenala Njirammadzi-Maleta, John Appiah, Janvier Hitayezu, Mukami Kunga, Genevieve Po Gee Fung, Rahimi Abdrazak, Shu-Ling Chong, Jhong-Lin Wu, Jeong-Yong Lee, Damian Roland, Bressan Silvia, Ruth Logan, Yolanda Ballestero, Ozlem Teksam, Lina Jankauskaite, Graham Thompson, Vikram Sabhaney, Yasaman Shayan, Elysha Pifko, Julia Lloyd, Khalid Al Ansari, Franz E Babl, Elliot Long
Despite all hospital-specific CPGs across an international cohort being of low methodological quality, most aligned with SSC 2020 for key time-critical recommendations. Clinically important variations existed in fluid resuscitation composition and timing of steroid administration.
OBJECTIVES: To evaluate the methodological quality of hospital-specific paediatric sepsis clinical practice guidelines (CPGs) from sites participating in an international study using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool and to assess the consistency of treatment recommendations and concordance with the Surviving Sepsis Campaign 2020 (SSC 2020) international reference standard.
DESIGN: Cross-sectional appraisal of hospital-specific CPGs.
SETTING: Hospital sites participating in the Sepsis Epidemiology in Paediatric Acute Care International Study across five continents.
PARTICIPANTS: Hospital-specific CPGs for the acute care management of paediatric sepsis.
INTERVENTIONS: Hospital-specific CPGs were appraised independently using the AGREE II tool and classified as high, moderate or low quality. Consistency across guidelines and concordance with SSC 2020 were assessed for 12 key treatment recommendations.
MAIN OUTCOME MEASURES: AGREE II domain scores and overall quality rating; consistency of treatment recommendations across hospital-specific CPGs; concordance of individual CPGs with SSC 2020.
RESULTS: 14 hospital-specific CPGs from 13 countries were included. All were rated as low methodological quality overall; the rigour of development (range: 0-50%) and editorial independence (0-58%) were the lowest scoring AGREE II domains. CPG concordance with SSC 2020 ranged from 42% to 100%; consistency across the 12 treatment recommendations ranged from 43% (steroid indications) to 93% (initial laboratory investigations, time to antibiotics and fluid bolus volume).
CONCLUSIONS: Despite all hospital-specific CPGs across an international cohort being of low methodological quality, most aligned with SSC 2020 for key time-critical recommendations. Clinically important variations existed in fluid resuscitation composition and timing of steroid administration.
TRIAL REGISTRATION NUMBER: ACTRN12621000920097.