The quality of guidelines in pediatric surgery: Can we all AGREE?

Anna C. Shawyer, Michael H. Livingston, Veena Manja, Melissa C. Brouwers

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Objective Guidelines are meant to facilitate evidencebased clinical decision-making but vary in methodological rigor and quality of reporting. We assessed the quality of guidelines published in major pediatric surgery journals. Methods A MEDLINE search of 4 key pediatric surgery journals was performed. Included studies had guidelines, clinical practice guidelines, and consensus statements as a subject heading or keyword. Evaluations of guidelines were excluded. Eligible guidelines were assessed by three reviewers using the Appraisal of Guidelines for Research and Evaluation (AGREE II) Instrument. Results Our search identified ten guidelines for review. Agreement for study selection was excellent [K = 0.81 (95 % CI 0.63–0.99)]. The mean AGREE II score for individual guidelines was 18 % (SD 5.7 %). The bestscored quality domains were ‘‘scope and purpose’’ [mean score 49 % (SD 8.7 %)] and ‘‘clarity of presentation’’ [mean score 40 % (SD 18.7 %)]. The poorest score was for ‘‘editorial independence’’ [mean score 2 % (SD 3.7 %)]. Conclusions The overall quality of guidelines in pediatric surgery, using AGREE II, is poor and may lead to inappropriate clinical decisions. Increased awareness of proper reporting and the methodological requirements for guideline development are needed to optimize the potential of guideline recommendations to improve practice. Level of evidence n/a (Quality Appraisal)

Original languageEnglish (US)
Pages (from-to)61-68
Number of pages8
JournalPediatric Surgery International
Issue number1
StatePublished - Oct 22 2015
Externally publishedYes


  • Evidencebased medicine
  • Guideline
  • Quality appraisal

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery


Dive into the research topics of 'The quality of guidelines in pediatric surgery: Can we all AGREE?'. Together they form a unique fingerprint.

Cite this