EVALUATING CLINICAL PRACTICE GUIDELINES FOR HELICOBACTER PYLORI INFECTION IN CHILDREN

Perpetual Pereira¹, Philip Sherman² and Colin MacArthur²

¹The George Washington University School of Medicine, Washington, District of Columbia, USA; ²Research Institute, Hospital for Sick Children, University of Toronto, Toronto, Ontario

Helicobacter pylori infection is usually first acquired during childhood. Assessment of the quality of current clinical practice guidelines (CPGs) should help to improve patient care and establish effective management of this infection in children. This study aimed to determine whether CPGs making recommendations for the diagnosis and treatment of pediatric H. pylori infection adhered to established methodological standards for practice guidelines. Standards used for this evaluation were taken from a 25-item published assessment tool (JAMA 1999;281:1900-5), plus 10 additional criteria suggested by the American Academy of Pediatrics (Pediatrics 2001;108:1378-82). These 35 criteria covered guideline development and format, evidence identification and summary and formulation of recommendations, and provided a comprehensive set of standards by which guideline development and implementation could be assessed. Three pediatric consensus guidelines were available for critical appraisal. Two of the CPGs (designated JPG1 and JPG2) were published in the Journal of Pediatric Gastroenterology and Nutrition while the other (CJG) appeared in the Canadian Journal of Gastroenterology. Overall adherence to the standards was 31% (JPG1), 66% (JPG2) and 37% (CJG). Standards relating to guideline development and format were commonly adhered to (80% JPG1; 80% JPG2; 70% CJG). Elements for evidence identification and summary showed poor adherence by two of the CPGs (20% JPG1; 60% JPG2; 20% CJG). Standards on formulating recommendations were also poorly satisfied by the same two guidelines (20% JPG1; 80% JPG2; 40% CJG). Additional criteria established by the AAP, which included education of users and defining specific outcome measures, showed the least adherence (0% JPG1; 50% JPG2; 20% CJG). These findings indicate that existing clinical practice guidelines for the management of pediatric H. pylori infection do not completely satisfy established methodological standards. Improvement is required in several areas specifically identifying and summarizing the evidence, as well as formulation and implementation of CPG recommendations.

Funded by the American Pediatric Society/Society for Pediatric Research - Student Research Program.