title: Evaluation of the quality of guidelines for acute gastroenteritis in children with the AGREE instrument.
abstract: OBJECTIVE
  The aim of the study was to assess the quality of clinical practice guidelines (CPGs) using the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument, a validated international tool.
  
  
  METHODS
  CPGs were identified by searching MEDLINE (1966-January 2009) and Embase (1988-January 2009), CPG databases, and relevant Web sites of agencies and organizations that produce and/or endorse guidelines. Included in the study were CPGs in English that addressed the management of acute gastroenteritis in children. Retrieved CPGs were evaluated with the AGREE instrument for quality assessment by 6 independent reviewers. AGREE consists of 6 domains for a total of 23 items.
  
  
  RESULTS
  Nine CPGs were identified. Four were evidence based (EB) and 2 of these included tables of evidence. Eight CPGs (88%) scored <50% for "applicability," 7 (77%) for "stakeholder involvement," and 6 (66%) for "editorial independence." Compared with non-EB CPGs, EB CPGs had higher quality scores for all AGREE domains, with a better score for "rigor of development" (P < 0.001), "stakeholder involvement" and "clarity of presentation" (P < 0.01), and applicability (P < 0.05). Over time, the quality of guidelines tended to improve. The main recommendations of CPGs were similar. However, there were differences in the treatment of diarrhea, namely based on the settings and circumstances in which CPGs were produced.
  
  
  CONCLUSIONS
  The overall quality of CPGs on acute gastroenteritis management in children is fair. Aims, target population, synthesis of evidence, formulation of recommendations, and clarity of presentation are points of strength. Weak issues are applicability, including identification of organizational barriers and adherence parameters, and cost/efficacy analysis.
authors.affiliation: Department of Pediatrics University of Naples Federico II, Naples, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Lo Vecchio
authors.forename: Antonietta
authors.initials: A
authors.lastname: Giannattasio
authors.forename: Christopher
authors.initials: C
authors.lastname: Duggan
authors.forename: Salvatore
authors.initials: S
authors.lastname: De Masi
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Ortisi
authors.forename: Luciana
authors.initials: L
authors.lastname: Parola
authors.forename: Alfredo
authors.initials: A
authors.lastname: Guarino
mesh_terms: D000208:Acute Disease; D002648:Child; D019317:Evidence-Based Medicine / Q000592:standards; D005759:Gastroenteritis; D006801:Humans; D017410:Practice Guidelines as Topic / Q000592:standards*; D015397:Program Evaluation / Q000379:methods*; D011786:Quality Control
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